got a prescription, a a wheelchair i do not need, what happens next? guest: take those and lock them into the computer. and everyone of those complaints is assigned a tracking number. medicare has a program integrity unit that is separate from the inspector general's function. their job is to forward that down to the cognizant agency contractor, you know, someone out in the field to say, mr. smith said he did not get a wheelchair from dr. jones. look into it. then we can send an investigator out if there appears to be fraud. we often cannot get to all the cases that we would like to refer over 1400 cases a year to other agencies. things that we believe our fraud, but we do not have the resources to work those cases. but we have great partners in the department of justice. the medicaid units have fraud units. units. we send a lot of this work to

the states. host: boston, linda, democrat, good morning. caller: good morning. in my situation, i had to go on medical disability. i had worked all my life. i ended up having to get a lawyer because i was miss used three times, which i could not afford. and they took money for the lawyer. it took two years to get it done. done. i was only awarded one year . a husband was in and out of . . the economy has risen. i have a plan d prescription plan. i'm a diabetic title oype one.

i want to know -- when you have these conversations, which are related, how do i get through to a real person? who can help me? guest: i am probably not able to answer your question. i do not have enough information about your particular circumstance. it sounds like you're doing the right thing. you have worked through the system. i would suggest you talk to one of the lawyers that is working with you. host: james tweets in -- guest: there are a number of proposals out there. it's hard to talk about a specific bill. and number of the issues that we believe would be helpful would be things like making it more

difficult for scam artists to get into the program by changing enrollment standards. instead of it being a right, it would be a privilege. you would have to prove you have integrity. we think more resources will allow us to put agents on the ground to talk to witnesses to find out if there are criminal elements of whaafoot. the vast majority of them were honest. they need help. they need to set in place internal control mechanisms, of its common traits.

-- control mechanisms and training. guest: a do not know of that is true. if you go through parts of dade county, you will see office building after office building with hundreds of durable medical equipment companies listed. if you knock on the door, you may find there's nothing on the other side of the door. host: could they have a warehouse? is it possible? guest: it may be possible, but it is not legal. there are specific requirements for what you have to do to be a supplier. you have to have an office treated has to have posted hours. you have to be running a business.

our agency found that these are just shelves. sometimes they are storage bins or empty pizza huts. these are not businesses. host: why is south florida so attractive? guest: part of it is that there is a significant senior population there. health-care fraud is byviral. people learn how easy this and their brothers, cousins, and friends get in on it. south to florida has become the nation's hot spot for health care fraud. for certain parts of the committee, everyone is doing at. host: do people go to jail? guest: more and more people are going to jail. one of the successes of the strike force model is to get people off the streets and into

jail. we have put over four hundred people into prison in the last year as a result of the strike force model could we also throw out a lot of people from the medicare and medicaid program based on misconduct. be excluded them -- we exclude them. host: west virginia, you were on witare on with lewis morris. good morning. caller: good morning. i was reading an interview with malcolm sparrow. guest: i have a signed copy of it. caller: in this interview, he said that you folks estimate 3% is fraud, which is $60 billion.

he thinks it could be as high as 30%, or 20%, which could be $600 billion in fraud. he said we do not know how much is being lost. we should know. the government knows how to measure it, but it is avoiding doing it. the news would be too bad. he goes into detail exactly how you are refusing to measure the exact profit. i am sure you know this argument. guest: i am familiar with the argument. i think there are some assumptions teammate which we do not share. first, it has got to be recognized that successful frauds, by the very nature, are undetected. i'm not sure we will ever know the full extent of fraud. i do agree it is possible that the fraud is far more extensive than we think. one of his point is that a very clever fraud scheme has the

appearance that everything is regular, so it is harder to detect. i do not think we know what the fraud rate is and we are hiding it from the american people. this administration has made a real point of promoted transparency. we would benefit from having a more precise number. we are finding ways to identify the fraud quicker. we are finding ways to identify it through systems that are a lot faster than we have in the past. host: barbara in lexington, indiana, please go ahead with your question. caller: good morning. host: please go ahead. caller: thank you for having me.

i think we need reform, incremental reform. i was born with agwith a degenerative disk. there's nothing that can be done but to keep me on pain medication. i asked my doctor why do i have to come every month? it is a waste of money for me to be there and spread disease. it's a hardship for me to come down there every month. i was told that it is because of the bureaucrats in washington insist that we come down there and go to the doctor every month. i have called in reported medicate fraud. all i get is, "ok, thanks for calling." i never get a response. guest: i'm sorry that you have been inconvenienced. unfortunately, it is on an individual case when someone

such as yourself has to go through the extra hassle. one of the reasons a role like that is put in place is because our experience has been, and in some instances, people continue to draw benefits when they no longer need them. like any rule, sometimes it can be over applied, or not tailored to the needs of an individual. as to your concerns about making a referral or complain about health care fraud, that is most unfortunate. it should not happen that way. we do hear complaints from seniors and those who have gotten health care benefits that they have filed complaints with the medicare and medicaid program and have not been satisfied. peirce, thank you for doing that. know that we are trying to do better. we've been in conversations with the medicare program to try to improve the way they respond to allegations of fraud.

we are conscious of our duty to be responsive. we're trying to do a better job. host: lewis morris, department of health and human services deputy inspector general. the annual budget in his office, about $300 million. a staff of 1500. 80% of their work is dedicated to medicare and medicaid. riviera beach, fla., grace, good morning. caller: good morning and thank you for taking my call. i am a diabetic and i receive my diabetic supplies through the advertised company. one thing i do dnot understand -- when i get the copy of the bill, it always seems to have more test strips

then i get. when i asked for batteries, i never get the right of countries. when i called back and i tell them that you sent the wrong batteries, they never send me any batteries. i'd tell them i need alcohol wipes. i may or may not get them, but the paperwork always goes into medicare that i received all this stuff. host: is that fraud? guest: i do not know. it sounds like the first thing you ought to do is contact the company, which you have been doing tree may be said to them a letter or in the mill -- maybe send them a letter or an e-mail.

bring the medicare program into the discussion with the supplier. this may be a billiong error. that is the first thing to do, to try to pursue this with the company and the medicare program. if having done so you conclude that they are charging us for services that were not provided, called the medicare program hot line, 1-800-hhs-tips. host: teresa, you are on with lewis morris. caller: good morning. i am amazed that there has ever been anything done. i did get a company shut down way back when because there was so much fraud. they operated in all these

counties. they threatened me when i talked to them about it. they gave me an explanation of benefits on everything. this did not happen until the medicare and medicaid bill went through and was pretty much forced on everybody. it took years to get any help. even when i would call to tell about frauds in my hospital bills, and how poorly we were treated in emergency rooms, they just leave you there on the table. it is wasting the tax dollars it is wasting the tax dollars when you were rushed th caller: i feared to tell them

anything because they ended up putting it on your health care medical records. host: thanks for sharing your story. we only have a few minutes left. we have not talked much at all about pharmaceutical companies and the fraud uncovered there. according to your office nearly $3.5 billion in fraud settlements was paid out in 2009 so far. where did the money go? guest: expect to the medicare trust fund to provide services to senior citizens. all that money by law is directed back to the trust fund. there are two ways to get it. there are criminal fines posed by courts and false claims settlements. these drug companies pay both criminal fines and civil settlements. those civil settlements are brought together partly by whistle-blowers who bring information to the government, give us the documents we need to

build the case. those whistle-blowers get paid millions of dollars as a result of their contribution to the fight against fraud. it is a very effective way to identify crime we not otherwise be able to detect. it is so and so it within a corporate structure. the whistleblower benefits. the taxpayer benefits. then it goes back to the trust fund. host: healthcare fraud recoveries such as medical equipment companies and things like that -- about $1.60 billion has been recovered so far in 2009. en recovered so far in 2009. besides medical equipment, what is another avenue for people to use when they want to commit fraud? medical equipment, buiilling, infusion therapies. we have discovered that in south

florida, they are not getting the drugs they need. they are getting b12 injections. home health is a hot spot for fraud. people are supposed to be getting services in their homes. they are not getting those services. those are two other examples of the type offs. host: middletown, new jersey, bob. caller: i am happy to see mr. morris on, especially after the "60 minutes" interview. where are the indictments and the prosecution's? listen to him, he explained that there are many prosecuted, which i'm happy to see. i am happy to see and hear today. guest: you will be pleased to know we brought 700 convictions this year alone. by the end of this year, we will

have brought back $4 billion as a result of the efforts of law enforcement officers and prosecutors. we are on the job and we appreciate your support. host: if you could change one olaw, what would it be? guest: to make it easier for the medicare program to scrutinize to the lead in the program and to stop payment faster. . >> and as the focus on health- care legislation continues, c- span's health care hub is a key resource with speeches, congressional hearings, town hall meetings, and more.

and to show you what some groups have been saying we have shown you several ads made by national organizations. here is one released by the republican national committee. >> saturday night as americans laid it down for sleep moderate democrats laid down their beliefs. sold out their constituents. ruled by pressure from barack obama and harry reid and devoted to move afford a government-run health care bill. one member sold her vote to the highest bidder. one member sold out his principles. two more lost what little credibility they had on fiscal responsibility. another put the interests of the left of his party before his own state. another voted one wait after saying she was for another. it is no wonder why democrats and voted in the dead of night.

>> the senate is currently on its thanksgiving recess but when the return on monday health care debate will certainly dominate. members are being allowed to offer amendments during this recess. they planned to begin debate after their return. all of them live when they do. health care debate begins at 2:00 p.m. eastern on c-span2. in 10 minutes we will bring you discussion on the global food shortage, the efforts being taken to reduce hunger worldwide. we will hear from people who work for the u.n. program. as well as from the president robert zelig. that is 1:30 p.m. eastern scheduled as the start time. until then, programming from this morning's "washington journal."

-- the downpour we have had in the last 24 hours things have been moved to the east room. mario french joins us on the phone from dallas. thanks for being with us. but now ask you first of all, this week is as much ceremony as it is policy. what goes into planning for this type of ceremony? >> there is a great deal of planning, as you might know. it begins very early. and exactly about the time that the national security council and the president decided upon a visit. the chief of protocol calls a meeting at blair house and invites the white house manager, state department, the embassy from the country that will be visiting, national security council, secret service, a diplomatic security, almost anyone that would have a part in this visit.

from there, a senior broker -- senior protocol visit officer is appointed to take the schedule from the white house and the state department on a minute by minute schedule for both the president and the prime minister from the time they touched down in the united states at andrews air force base until they depart. >> who determines that india will have the first state visit? and why india? >> bad decision is made by the president and his advisers -- of that decision is made by the president and his advisers and security council. i'm sure it comes about because of our relationship with various countries and to we want to -- who we want to order for a state visit. everyone is very happy that this year is india. >> president bush -- host: president bush favored having a state dining room, which would see typically 140 or 150 guests.

you are no stranger to the south lawn tense during the clinton administration and they are back now. total guests are around 400. what led to that decision? guest: i'm not sure what led to it, but usually it is that the first lady would like to be able to accommodate more people for the state dinner. india is a very large country. we have a lot of people in the united states from india. we would like to be able to cut -- to showcase our country and the white house and what we do here for other countries. a tent is just like room when you actually go into it. it is very, very beautiful. you would probably not know that you are not inside the white house. it is not advertise that it is a

tent. most administrations and enjoy doing this. more people can get to know each other, visit, and it does promote relationships between the two countries. host: the other closely watched by respect to this is the guest list we have a preview of some of the big jewels invited. -- of the some of the individuals indicted. we have mayor bloomberg, steven spielberg, david geffen of dreamworks, the republican governor of louisiana. also, a pro winfrey is on the list, but bill clinton is not on the list. guest: i think that probably former closet -- president clinton is giving secretary of state hillary clinton the advantage of being able to portray her office and the

things that she does without his presence. he is, at this point, a very famous individual and the emphasis tonight is on president and mrs. obama and the secretary of state, the vice president, and the prime minister and his delegation from india. host: your of the white house, the weather forecast showed rain continuing overnight. what led to the decision to move this event inside? guest: i'm sure the obvious is why it has been moved inside. and my goodness, what an undertaking that is. the military district of washington who directs the ceremony with the military outside on lawn -- bolon always has a plan to -- outside on the golathe lawn i'm sure went intoa

very fast kiron was working into the wee hours of the morning to make this change. they're doing beautifully and if it will work out fine. but it is such a gorgeous are one and so impressive -- ceremony and so impressive when it is done on the south lawn. it is a shame it had to be changed this morning. host: she served during the clinton administration as the chief of protocol. one question of planning is the dinner menu because the prime minister is a vegetarian. guest: yes, the white house social office does plan a dinner menu. i wouldx++!s that maybe lamb ( served, and of course, fresh vegetables, knowingco that he ia vegetarian. the protocol office puts all of this together with the embassy

with -- to get the likes, dislikes, food preferences for the prime minister and send all of that to the social office. it is worked on until it is protected by the embassy and they come up with a fabulous dinner menu. i am sure it will be quite acceptable to the prime minister. host: i will put you on the spot for does a moment, if i may. have you ever been in a situation during your years of the white house where things did not go as scripted? and if so, what were the circumstances and how did you respond? guest: [laughter] occasionally we did have things that did not go esker did. what you do is you improvise. -- did not go as scripted. what you do is you improvise. i learned from very professional people there what you do when something does not go right.

you do it with a smile and use dave barry colman - >> saying that he agreed to accept invitation to visit india later this year. more coverage later tonight. >> is giving day on c-span. at 10:00 a.m. eastern bill clinton is on hand to present steven spielberg the metal from the liberty constitution center. also, a panel assessing the obama presidency. and from the jfk library in museum, these guests on

terrorism and nuclear weapons. at 5:00 p.m., the hip-hop actor and artist. a thanksgiving day on c-span. >> coming this thanksgiving. american icons, three nights of the original documentaries on the iconic holds of the three branches of american government. the supreme court, home to america's highest court, reveals of the building in exquisite detail through the eyes of the supreme court justices. then oat 8:00 p.m. eastern, we should agree in public places as well as the really-seemed spaces. saturday, the capitol. three memorable nights, thursday, friday, and saturday at 8:00 p.m. eastern.

get your own copy of the three- the upset. -- 3-dvd set. >> is is the brookings institution in washington, d.c. here for a discussion on the global food shortage. efforts taken to reduce hunger worldwide. we will hear from people who work for the u.n. world food program as well as from the world bank president robert zelig, expected to speak. the forum is expected to get under way now. this is alive. we showed you earlier the joint news conference with the indian prime minister. during that conference the president said is his intention to finish the job in afghanistan, but the afghan people ultimately must provide for their own security. reporting today, that the president will speak to that possibly next tuesday.

president obama is in town. the state dinner tonight at the white house along with meetings today with the vice president and defense secretary robert gates. the house is out for the thanksgiving recess. the senate will be back from their break on monday. the health-care debate will get under way on the senate floor. the house returns on tuesday, december 1.

>> wedding at the brookings institution for a discussion on the global food shortage. robert selleck will be among those who will speak. -- we're waiting on this discussion. later tonight here on c-span, at 9:00 p.m. we will show you the rivals to the state dinner, do a preview ensure you the toast by

president obama and the indian prime minister.

>> coming up, a discussion on global food issues. that will include robert zelig, the president of the world bank. until then, a look at what is coming up this thanksgiving week on c-span. thanksgiving day, at 10:00 a.m. eastern bill clinton is on hand to present steven spielberg with

this year's liberty medal. also, stanley greenberg and alex, part of a panel assessing the obama presidency. from the jfk library and museum, nick and leslie on terrorism and nuclear weapons. at 5:00 p.m. the hip-hop artist on youth mentoring. >> a look at the audience at the brookings institution.

>> thank you all so much for coming out this afternoon despite the miserable weather. my name is homi i'm a senior fellow at brookings. i will moderate this discussion

today. let me begin by asking any of you who have not already done so to please turn off your cell phones, pagers. while you are doing that i will introduce a tremendously distinguished panel. we have three people who are the real global leaders in this fight against a global food crisis today. so, starting from my right is rob zelik, the 11th president of the world food bank in 2007. it is an institution that runs about $4 billion per year for agriculture, and the president

has announced plans to may be double that by 2012. i think the bank will be an important player. before that he has worked in the private sector, was of the u.s. trade representative, and is well known as a champion of free trade. he described malnutrition as the forgotten being and has been a very strong advocate to pay more attention to nutrition. welcome, president zoellick. next to him we have sam worthington who is president and ceo of interaction. it is of the largest umbrella grouping of u.s. non-profits and foundations through active

overseas development. all the household names you will know that deal with food and hundred issues in developing countries are part of that grouping. world relief, care, bread for the world, save the children are all part of interaction. interaction members are something like 150 -- dispersed something like $6 billion per year. not just for agriculture. it is a pretty substantial organization. the last thing that i saw from interaction was their strong support for u.s. legislation on a global security act which calls for the appointment of a special coordinator for the global food security.

maybe that is something we'll come back to talking about. the, josette sheeran is executive director of the u.n. world food program, the world's largest humanitarian agency. it feeds 102 million people in 78 countries. last year she mobilized 5 billion u.s. dollars to help feed the world. this year again she has warned about the perfect storm of the food, fuel, and financial crisis coming back, causing an urgent hunger problems. it is she who coined the term about the tsunami that we have borrowed for this discussion to describe the global food crisis. so, today we will have a panel

discussion. i will start with a few questions for our panel. that will take us something like 40 minutes or so. then i will open it for questions and answers from the floor. because the panelists decided not to make opening statements themselves, i thought it might be useful to quickly give you a few facts about the issues. it is just to try to put this into perspective for the friendly discussion. i came up with a top-10 factoids left on food and hunger. i like to go through this quickly. number one, the target on hunger is to reduce the proportion of undernourished to 10% by 2015.

today the estimate is 17%, down from 20% in 1990. we have not gotten very far. we're past the halfway mark. that 17% is equivalent to 1 billion hundred people worldwide. number two, 200 million of these undernourished people which is one-third of the total live in sub-sahara in africa. number three, more than 60% of the chronically hungry are women. four, 150 million children under the age of five, one quarter of all the children in developing countries, are underweight. 5, iodine deficiency appears the mental development of 40-60% of developing countries' to them.

26% of infant mortality deaths can be traced to non attrition. 7, agricultural labor productivity in sub-sahara in africa has declined over the past two decades for the most part even though output has gone up slightly. 8, post-harvest losses in developing countries are estimated somewhere between 10- 40%, and then there is another significant fraction which is wasted in retailing and consumption processes. nine, the share of aid going to agriculture of production and food was 33% in 1970. it declined to 17% in 1980. 4% in 2006, and has begun to recover a bit.

10, international food crisis today are about 50% higher than in 2003. even though they have declined from their peak level in 2008. cereal prices are up by about 70%. that is the world. it is the description of an enormous problem. certainly for me the dimensions are a little overwhelming. the challenges of reported seem to cover everything from food production to marketing to income levels, composition of demand, a level and targeting of resources. there is a vast array of these issues. i thought it would be useful to start our discussion by talking a bit about priorities. mr. zoellick, would you take us off by telling us a few short remarks about why food was so

neglected in the past. why do we have this collapse of attention? what let us into the current crisis? what do you see as priorities going forward? >> let me first thank you for having the three of us. sam has been a fantastic partner. and all of you who work with the ngo's know what a challenge is to represent a. diverse sam has done so effectively. one point, during a crisis like this everyone is under strain and that includes the charitable community. some of the work we have done, some of the ngo's had been good partners in the fields as well as advocates. do not forget them with your year-and accounts. josette has been a colleague for

number of years. you have seen how she has already calling it two good phrases -- i can never catch up with her. thank you for the compliment. it is really she who helped to draw my attention to the nutrition issue with an article we tried to focus on together. it is a good example of how the bank can work with other agencies. one good piece of news, $4 billion of agricultural investment. we are now up to $6 billion. we still have to increase that. to your particular questions -- there were a lot of things that led to the decline for the focus on investment in agriculture. there was perhaps an over confidence in the ability of global agricultural production and the ability of trade markets to work effectively. and perhaps an assumption that is part of the development process.

while many people know that agricultural areas are poor, people who might live would be drawn to other economic applications with growth. at the bank we had done the world and develop a report a couple of years ago that focused on the benefits not only for the people involved in an economy for growth in every culture, but because these are rural activities they can to have a much greater multiplier effect to overcome poverty. where we thought we ought to see where we could stepped up activities -- there have been throughout history tremendous examples of investment. like the green revolution. one of the areas we're trying to focus on is to look at the whole value chain. everything from property rights to seeds to fertilizers to

marketing distribution issues. that speaks to your second question, the cause of the big price spike. part of it was multiple effects. it began with low stocks. you continue to have them today. you buy most with some special events. in one case it was some drowse, difficult weather conditions. a linkage that has changed, a much closer one between food and fuel prices. food not only an input, but particularly with biofuels there's a degree about the rate of connectivity. we found some high ones. that crisis quickly lead to a breakdown in markets. in this case it was not a

problem of markets being too expensive, but failing to work. part of it began with the rice in the philippines. 7% is the traded market, rather thin. then you have another phenomena that is different. commodities in general including food ones are not considered an asset class for investors. different investors will go where they see price opportunities. what looked like a potential price spike -- people were moving into this as a potential investor class. then, what josette and i tried to stop -- export barriers and a boarding. i experienced this in the oil crisis or people would keep full tanks of gas -- all of a sudden

it increased the overall demand. those together shot prices up. one other important thing, to keep in mind -- you have to look at a global market conditions. within those the will be particular crises. you may have natural disasters. you may have conflicts. any multi-dimensional problem will probably need such a solution. one of the lessons is there is no one syllable it. i would just highlight five areas. first, and we're fortunate to have josette and some of her team here -- is a important for the world to recognize the front line role that the world food program place. i'm not just using this as a term -- she would probably not even mention this, but she just

came from the middle east were somewhere in hospitals from being shot. this organization loses people every year through some of the most dangerous circumstances. a problem in funding is there must be funded from scratch every year. your normal funding was about $3 billion per year, last year was up to about $5.50 billion. to reserve from scratch is very difficult. our item money is done through pledges in our organization. one of the issues is to improve the world funding system. another piece that she and her people have done well with is to not see it only as a food issue, but to locations and nutritional aspects. there have been advances like working with the private sector.

how can we take this business model that came from the 1960's and improve its efficiency? it ranges from working with the meteorological organization to do long-range forecast in africa, to get lines of funding, and effective risk-management. so, you don't have to see the crisis, by the food, transport it -- all fraught with and efficiencies. with a little creativity, and it looks like she has gotten the australians to helper -- we could probably make it more effective and cut costs. when people talk about making multi-lateral institutions work, you have some practical examples. second, and a related issue -- use of targeted safety nets. one of the lessons we learned

coming from the 1990's crisis -- the macro-economic situation is not enough. if you did not have money going to sit in their programs kids got pulled from school, did not get food and lost an intrusion. you could lose a generation. we have done research in guatemala. it looked at controlled set. kids that got better nutrition, their earning power was 45% higher than that of others. frankly. how do you deliver? with some countries with conditional cash transfer programs you have one model. one way we have tried to team up with the world food program is to look at things like school feeding. how can you take a model and expand it with nutrition? reach back to kids that are more vulnerable -- the real danger is in pregnancy within the first 24

months. how can you take the to padded capacity of a country with the food for work program? how to increase productivity -- looking across the value chain. if we are joined how can we attach that to the procurement of a program? fourth, a trade. we solved this tremendous problem that they're really was no international prohibition or even customary will against creating barriers to food purchases, even for the world food program. we were running around the world. at a time when everyone makes speeches, could we at least get some understanding? perhaps a un declaration that says that do not prevent purchases from the humanitarian organization. but obviously there are other related areas.

the last, a critical one, the research and development agenda. we work with the gates foundation. some of this is just expanding what is out there. do not hold me to the exact figures. about 5% of the seeds our enhanced compared to those in southeast asia. i'm only talking about hybrids, not even advanced technology. with research i think we could help to deal with the benefit of the food. the other question is how to get the research out in the field. the u.s. and europe have had histories of extension services. how can we build these into

developing countries? with any problem my worry is that this is not a problem that never ended, but am worried that we could be through another round of this. if you watched that rice market, the philippines has had a challenging tender. i was speaking with some indians and it looks like india will import rice for the first time in a long time. combine that with a lot of liquidity in many markets. i'm a little concerned we could see our selves to dig ourselves in 2010 repeating this problem. >> thank you. that is fairly comprehensive. it is a very daunting agenda if you have set out to tackle. >> there are things, part of the challenge here is to get a problem like this that is multi- dimensional. everyone goes away staggering.

it looks like the australian might help us -- they could make a big difference. why does some un agency have pre-funding but another cannot even get a credit line? there are ways. we get advanced funding, a three-year commitments. why can't they? if you can do that you can free up -- we're not exactly untutored in futures markets which we can use for shipping and food prices. there are many ways that brinkley if governments did not just talk about this, but looked at the mechanisms, you could improve this pretty quickly. >> that sounds like those cue for you. you see the food crisis possibly returning. we have not even gotten to the old crisis before.

and that you might even have to ration your abilities to provide food in some countries. how do you prioritize? . . >> what we are seeing today with the financial crisis is a compound issue that is driving the numbers of hunger in the world. this comes from our food program in rwanda. there are 1 billion people that will wake up tomorrow not sure that they can fill a cop like this with porridge or food.

that is -- a cop like this -- a cup liekke this. this is destabilizing. the numbers keep increasing. it went from 846 million to over 1 billion. it is impossible to keep up with this. we partner with over 1000 ngo's. you are seeing new types of partnerships. working with the world bank has really been a blessing for us to get the kind of policy guidance and expertise that can come with the types of programs we do so they are built in with a more sustainable foundation. we released with the bank today, a book called "rethinking school feeding," that looked at how the activities in many countries, including -- programs that

provide a basic safety net. in the developing world, these things are such a part of life that we do not realize the effect they have on the stabilization of hundred numbers. in the u.s., one of every six americans is drawing on a food safety net. when times are tough, these safety nets can catch people who get pushed into hard times. most of the world has no such safety net. the safety net is, will there be a humanitarian response to help deal with these pressures? so all the risk is in this cup. this is where you see the volatility happening, and there is not any mitigating institutions in between. i am sorry. that is another example of good activity, but, so, what we are really looking to is working with the longer-term partners to

model programs that can be part of this stabilization and can be of benefit. if you fill this cup with produce from local farmers, you now have a virtuous circle where you are pulling in a locally- produced goods. you are increasing household incomes by 10%. if you give kids an extra ration it at the end of the week, for perfect attendance, especially girls, you are building in a logic and a 25% increase in how to cook -- household income. if you put sprinkles of micronutrients, another example, costs of a penny or two, you are now changing the types of things like night blindness and the damage that can happen to kids. we know we have to get the under two-year-old spirs. but also for kids to be able to

go to school and not have to beg for food. we have tried in the wake of the food crisis to ramp up and also learned with partners that can help us do our work in a more effective way. you are seeing new types of partnerships, including with the private sector, where we can learn better. cities are not empty calories. just a couple of thoughts -- so these are not empty calories. we want to make sure that this cup is filled. is it dealing with the underlying any trend deficiencies? with this multiple crises, the bottom billion is going into micronutrient deficiency epidemic. the more you don't have access to adequate food, this damage is getting deeper. secondly, i think volatility in price and supply are with us for

the foreseeable future. after 30 years of basically food volume increasing and pricing decreasing, we are now seeing pricing very volatile. this is a very deep problem for poor farmers who are not sure that they should plan and invest, because they do not know what the price will be. it is a compound the problem. i would just call for two things -- one is effective safety net action, because the food crisis is in excess crisis. it was not, the starter, the production crisis. now you have the compounding factor. and people cannot access food if they cannot afford it. that is very, very critical. secondly, a risk revolution for poor farmers, a reduction in risk revolution. they cannot plan if they do not know where prices will be -- they cannot plant.

we are working with the world bank at the first pilot with usaid and ethiopia. these models are growing, where we can mitigate risk. we need some big, innovative thinking and partnerships to deal with the fact that these long-term drivers -- price and supply volatility -- are in place, such as climatic changes. the drought in india. the same thing we saw two years ago in australia. it affected the supply and drove the price. we are seeing scarcity in water and land. we're seeing conflict in -- and other drivers that are really with us for the years to come. and we have to have effective policy responses to them. >> thank you. you have emphasized the notion of safety nets as mr. zealot it

is well. -- mrrobert zoellick did as well. you're dealing with issues of lack of safety nets more than anybody else. in some countries, like india, they have their own safety nets. they have employment guarantee schemes. china has safety nets. does this mean we are talking more about a crisis in sub- sahara africa? is that the nature of the priorities? where do the organization see the priorities? >> first, thank you for the opportunity to join these distinguished organizations. i think part of the evolution of the world's response to these types of crises is that society is now seen as an active participant, indispensable to

the solution. the interaction members and so forth, especially, it -- it is a civil society in the developing world. it is the poorest country and their ability to reach out to poor farmers and workers. when we talk about the heart of this problem and the face of this problem, it is a woman farmer, living and marginal land, with poor access to water at a road where the market off at the -- often does not reach. her husband may have migrated to a local town. and her ability to feed her child depends on the cycle of the seasons. unfortunately, with climate change, those ratings are come lastining less frequently. and a further margin position of her ability to have a family that is able to feed itself, and

most importantly, have the proper nutrition to grow up healthy. that person, that family is at the heart of the world food crisis were facing. in many ways, that person has existed for millennia. and i think what has happened most recently with the onset of this crisis was a number of things that, to some extent, spurred nations to act. the first was perhaps the sense that we actually have the ingredients to make a substantive difference in the lives of this woman farmer. another shift is perhaps the fact that now that since the majority of the world's poor live in urban areas, urban hong work is a reality. that translates into riots -- or been hunger translates into riots. governments are concerned about what is happening to their people. the concept of dealing with under alternate -- with hunger

becomes one of the affordability of food for the urban poor, which fits right to the heart of the safety net. if you do not have those safety net valves well beyond africa, you will be confronting challenges with the urban poor and their ability to feed themselves. and they will translate that concern into political action on the streets. i think the key message, and i am glad i am sitting in the middle here, is that ultimately, any attempts to deal with food and security moves from a continuing, from emergency to long-term production. our challenge as a world as we need to be doing all of them at the same time. there has been a tendency is a surplus nation to say, we can feed the world. the reality is, yes, those resources are needed as a part of a safety net.

but increasingly, it is ultimately about the world's ability to feed themselves. it is the ability to have safety nets that are part of local and national governments' safety net plans and not an external ones. we are civil -- our institutions are filling the cracks in the global economy and the global attempt to ensure human well- being or around the world. as much as these are nimble institutions and quite large, some of our members have 40,000 staff, and has a massive infrastructure largely privately funded and literally tens of billions of dollars that go into these programs, to get to a situation where the largest funder of long-term agricultural efforts from the united states government for the last 15 years or u.s. ngo's and not the u.s. government, shows how far we have retreated from this problem. one of the positive things of

this latest food crisis, which is not over -- the prices remain very high in many countries. food insecurity continues to be the case. is that the world's attention has now focused on this crisis. the question then becomes, how you reach, its 70% of the world's poor are poor farmers, and the majority of them are women, how you reach them? and yes, it is about un institutions coming in when the system collapses and insuring that food is available to feed someone or are spared the ring with the world food programme e, with world vision, insuring that cup gets the last kilometre to a village so that someone is fed. that needs to happen. it is helping those women

farmers alternately have access -- ultimately to have access to markets. to be able to be organized in farmer cooperatives. to be able to have access to some form of routine irrigation. in many ways, our challenge is because we have built the systems that require large, a external inputs for production, she is not able to cope with large external fertilizer imports on some scale. how do we get to her level of scale? because it is the hundreds of millions of small-scale farmers that will solve this problem, and not a large, overall global production that is increasing distribution to these remote, rural areas through safety nets. is this small focus. it is a recognition that there is a real gender dimension. this is ultimately about the

ability to have women be empowered over their own economic resources. in many ways, i think there is a tendency in our country to look at this as a production problem, rather than a week -- the real heart of this is nutritional outputs. as to what extent our children -- our children healthier? are we able to see if your malnourished mouse out there? -- fewer malnourished mouths out there? i think this is why it is so urgent that we continued the waking up to this challenge. in many ways, it is possible this challenge will get worse. if you look at climate change and a 2% -- 2-degree increase of celsius world wide, you are looking at a 20% decrease in production of foods and sub-

sahara africa. that is making the situation worse, not better. it does mean that the ability to have food banks, the ability to tap stock set aside, -- to have stock set aside, the ability to have seeds, the ability to have that farmer to have the resources is a challenge. for the broader ngo community, our community has the tendency to operate with small-scale projects, help a group of farmers in a valley, enabling them to have better access to water, increase their production. this will not work unless we see ourselves as a broader fat -- broader value chain and rickie -- reaching out to markets. you have to be able to reach those markets. a top-down approach, the

traditional approach, developing the ability of the private sector to reach down needs to recognize the importance of helping the small-scaled farmer to reach out and giving her the tools. [inaudible] >> you have talked about this continuum between emergency assistant and a long-term productivity. at the end of the day, all of this comes down to money. your community has been very successful in mobilizing money for emergency assistance. do you think you can be as successful in mobilizing funds for the other elements that you have talked about? especially in today's environment, where i no foundations and charities are hurting, can you actually generate the funds to move in

this direction? >> sadly, nothing sells better than the emergency. that said, i think there is an educational responsibility that rests upon our community. we saw this without reproached hiv-aids in this country. there was a concerted effort to reach out to the public to understand the disease. this same becomes the question of the donor -- can you actually make a difference? the donor is looking less for the rest cup of feeding someone and the ability of helping someone feed themselves. the more we can explain that we are part of that solution, the more you will find that the public will continue to give. and they will provide the political will behind the resources needed to sustain, whether infusions of resources into world bank or "after wordsworld food programme .

e. as much as we can applaud the g- 8, we seem to forget, we seem to hit a high number and then the crisis goes, and then the numbers go back down to a lower level. i am hoping we are not waiting for a large gas scale famine -- large-saclca;ele famine in rwanda. we need to act now. because prevention is cheaper. political will -- political will comes with disaster. >> to you think your abilities to raise money -- do you think your abilities to raise money for short-term assistance are hampered by a broader call for a long-term funding? >> there are three points i would like to make. what did come to emergency response -- when it comes to the

emergency response, we have hundreds of millions of citizens caught in this -- bad governance, conflict -- in situations where they cannot eat, there is only one pool for emergency response. there is no university investment, no research endowment. the emergency money is all there is to reach those citizens who are somehow left behind without any food. so we have to keep that up. there will always be a need for it. the key is can we reduce debt load to really being true emergencies -- reduce that load to really being it true emergencies, were warheads. rather than being chronic cases. i think we have to tie and the logic of emergency response with long-term solutions. today, we spent 80% of our cash for food purchasing from developing world farmers

themselves. it is purchasing for progress which we are modeling with the bill and melinda gates foundation and with many nations. we purchased over $1 billion at of food from african farmers last year. in senegal, food-deficit nation, we were able to buy the salt. we are able to buy our salt and set a call from 7000, mostly women, a village producers who have a guaranteed income now. we do this with canada. they never iodized salt, because the salt produced at the village level, they do not have the equipment and training. when they sell salt in the village, it is iodize. the iodine deficiency disorder has been impacted by this. they are helping to feed their own nation. i am proud of that.

that's -- let's look at the $1 of investment there. it becomes a win for the women. it is the same dollar. secondly, it becomes a win because of the -- they are iodizing salt, and dealing with a larger health problem. third, the women are helping to feed their own children -- their own country. fourth, the child gets their ration of salt. this type of logic needs to be embedded. this is where the safety nets come in. if you are reaching children in school, you have -- multiple benefits. we have model school lunch programs and the schools have taken over those programs. it is not permanent charity. you are targeting the most needy populations, tying it to a logic of local production, and you can scale up when times are bad and scale down when times are not so rough. this type of things gets out of

a soup kitchen mentality, which has the least kind of win-win benefits. when ever you can tie into a logic that is building some stability, framework for action, building up local capacity. -- school lunches and school meals make a lot of sense in many countries. brazil's program or they give cash for people to buy from local farmers -- this is now creating a demand-driven and put into the society that is getting a hundred numbers down quicker than any other country. brazil is a curved-buster as far as income growth and how reduction, thanks to these types of interventions. the developing world itself has developed models that are very critical and vouchers for the urban poor -- a powerful tool

that help the stores and shops who were not having business. anytime you can tie in this kind of response that built of local markets, build up local response, invest and localities, i think you are getting -- we will find more support for these programs that actually built in sustainable solutions. >> robert zoellick, i know you are working very hard to get the $20 billion pledged. is this going to happen, and is this money going to be incremental, or is it something that will be taken away from whoever comes next to brookings and says, education is the key development priority? >> from what i can see it, it is going to be a mixture. -- from what i can see, it is. to be a mixture. let me connect that -- your

mentioned about what people support food and agricultural production and that aspect of food security as opposed to emergency assistance? what i was at [unintelligible] , i was worried that the pendulum was going the other way. others have helped get a better balance. some people thought that if you get people to produce the food, then you'll not have the crisis. and as she said, you will. one critical thing is to see this as a continuing. -- a continuum. take the notion of food aid and broaden it to food assistance. part of this, and development or any issues, there tends to the silvrer. bullet, as if there were not intelligent people who thought of these things before. the question is, how to keep the

food assistance program linked to the other ones? just to the point that both of them made about school feeding, i think one of the challenges, whether education or health or gender issues or food issues is, times are tough. governments do not have resources. how can you leverage a platform? as they mentioned a in brazil, this is one of these conditional cash transfer programs. mexico has one. it is a wonderful example. the cash goes to the poorest, but in return, they have to send their children to school. people get health checkups. the thing that is intriguing as you are able to connect education, basic health, basic sustenance. one of the reasons we are looking at school feeding is that frankly, a lot of people

grew up thinking of school feeding from their own experience. what this book looks at that we have put together is that in poor countries, local school is the natural community device. how could you take that an extended back? what you have seen is one is in addition to feeding the skills -- the kids at school, you give them food to take home. what else you try to do to use that to connect, and address the issue of those from pregnancy to two years. if you do the supplements, the new deal with the health issue -- the de-warming issue. you look to see how we can interconnect these more. i was on a task force were gordon brown looked at innovative health financing spread you can do a certain amount that way. but if you are going to be affected -- if you're going to

be effective, you have to look at other devices. taking it a step further, i think all of us can do a lot more to help people be in a position to help themselves by managing risks. at the end of the day, absent those weather calamities, you do want people to be able to stand on their own to 0 feet. but if you are a small-holder farmer, i always remember an incident in india -- the farmers are committing suicide. -- they are actually not a self- supporting farmers. they are just starting to make the movement into the market economy, and they drilled a well and they do not hit water and they have nothing to take care of themselves. one of the things that josette mentioned it -- we're doing this in malawi where you can do index

features. only 5% of the agriculture is irrigated. if it rains, you have good crops. if it doesn't, you are in deep -- in trouble. i get asked that we try to-- without replicating some of the expensive far -- farm programs, what can you do to offset risks of small properties facing global markets? part of the challenge is to recognize you have a global phenomenon, and if prices shoot up and because of rice tender in the philippines, it will affect everybody. you have special circuit map -- circumstances. one of the things that we should be better at is the customization of solution packages. in a way, one of the challenges, when people want to raise food security as an issue is not to just make a silver bullet, but

to see the interconnections. one of the things that, just in the nick of time, and this gives you insight on economists, when we were watching that commodity prices increase, and my morning staff meeting i was asking people, will this not put a burden on certain communities? the first response was, a lot of these countries will actually do well because commodity prices are increasing and they will get more income. the basic lesson was -- is aggregate. that may be true for some, but not true for others. this is one of points san mentioned. c. omwe of 16 programs with various groups, and we have one with

unicef and others, part of this is how to interconnect with other operations? that adds to efficiency. >> i will throw this open to the floor now, but i would like each of you to give me one sentence, if there is one thing -- i understand there are now silver bullets -- if you did have one sentence, what would it be? >> wow. talk about being put on the spot. a billion for a billion campaign, which we just launched, worth a billion citizens to have enough to eat connect. they connect with a billion who don't, and make sure that we have citizens connecting. we raised during the world food summit enough money from that

campaign to make sure that almost half a million kids had enough to eat. we are going to need this back up plan while we deal with long- term solutions. >> mr. worthington, one sentence. >> the political momentum has started. we need your political will to close it. >> mister zealot? >> i will endorse their spres. >> questions from the floor? gentlemen in the blue shirt? >> i am 8 bankrupt african farmer. the only farmer here -- a bankrupt african farmer. i worked with the world bank for five years, including a program in afghanistan. [unintelligible] i ran an operation in zambia, and my neighbors were poor women

and i helped them to grow food because they needed help. the men were not there. in zambia, the plan in november. the men came in december. so we helped them. we proposed to the world bank that they give us money to help our nam -- our neighbors -- 800 commercial farmers produced half the food. because of the imf and world bank, all 3 rascals, we were not paid. the price of food was kept low. instead of paying us with real money, they paid south africa with real money. i do not think this top-down approach works. [unintelligible] you have to think differently. i do not know how you do that.

>> was there a question there? >> it is statement. a value-added. >> thank you. >> i am the chairman of the organization of african professionals in diaspora. we're working with the african union to organize africans to play a role. my remarks or question relate to the issue of remittances from africans in diaspora. how do we engage in the world bank to enhance remittances. remittances -- the last estimates from the world bank but it to almost $20 billion. it is now declining. the crisis is getting worse.

the global crisis is hitting those of us in diaspora it so tha. the written started -- it relates -- the remittance target relates to schools, hospitals, food nutrition and all these areas. i get phone calls from my village talking about money, money, money. we have just finished a hospital in my village. the areas you are talking about is the areas we are tackling. the issue is how could we be engaged more effectively with the world bank and other agencies? it is a pity that the current level of engagement with the world bank in the african diaspora, i am sorry to say, is not very effective. we have sent an appeal to the

president of the world bank requesting that in his proposed reforms to please ashore these reforms a moat -- reflect a more effective engagement between the african diaspora and the world bank. this engagement is critical because these are the people could help these areas. can we find a way to meet the world bank? our appeal was a 20-page appeal. it was a complete assessment. we concluded it was not effective. we would appeal to the world bank president to give us a chance to explore more ways of making these remittances effective and targeted to these critical areas. the sooner you could do that, the better. we appreciate the proposals and

a stumble. -- at istanbul. >> a question at the back? >> hi. i with the state department. we have put together a very robust food security request to congress from the state department at usaid. we are holding our breath until december to see what comes out of it. there has been a lot of discussion and looking at what we are going to do with the funding, depending on how much we get back and put forth an agricultural request for many countries outside of some- saharan africa. my question to you, in a budget- constrained environment, where d.c. our global priorities, outside of sub-sahara africa?

-- were d.c. our global priorities? -- where odo you see our global priorities? >> i will take one more. there is a gentleman. >> thank you. russian tv. i have two questions. considering the situation, are there any threats to the united states, china and russia? the second question is why food prices went highwall housing and oil prices go down during the crisis -- while housing and oil prices go down during the crisis? >> let me give our panelists a chance to respond. then we will have one more round of questions. would you like to take a question about the priorities? >> i want to offer great thanks

to president obama for putting it on his agenda. -- for secretary of state hillary clinton for taking this up. when food security becomes the business of presidents, treasury secretaries and secretaries of state, you know you are moving the world in the right direction. it is rightly put at the top of their agenda. i will do what i can to urge that this be fully backed. i want to complement three revolutionary c's in this program -- country-lead. the administration is looking to countries for their own plans. they are looking to the rwanda, zambia, you got up, ghana, who are determined to be the next to it -- next generation of countries to leave under behind. that is excellent. also comprehensive. it is not just looking at production. it is looking at the zone of

access to food. how to connect people to the production? we saw brazil becoming an agricultural powerhouse, not getting those numbers down, and then changing their approach towards a zero hunger type approach. i think the comprehensive nature. for, collaborative. bringing in not only multi- lateral institutions, but the private sector, civil society and others to see what they bring to the table. you put gender front and center and recognize that women play a role. i think that is critical. i would say a huge part of this problem is in sub-sahara africa. it will be required to help feed the world. the world has to produce a lot more food. we will see a lot of investment going into africa today. but, i think rightly so, with so many countries poised to go over the tipping point of concord, i would not get the central

america's -- that tipping point of hunger, i would not forget the central america's of the world as they struggle with the pressures of the financial crisis and extreme weather and other crises. we would hope to see a little broader reach from the pace- setting countries that are ready to make it tipping point -- that tipping point out from under to food security. -- from hunger to food security. >> i agree with the point that a significant bottom-up approach needs to be part of the solution. and the solutions have to be local. linking farmers to farmers makes sense. when you look in our community, it is 98% locally staff. this is a global solution with

local capacity. it is building on that capacity. when we tend to think about foreign assistance, there tends to be a thought of official development assistance. let's broaden that a bit and talk about private flows, total private development flows is about $53 billion or around the world. our community, for every dollar we get from the u.s. government, has $2 of private resources. there are massive flows that are private. on top of that, you have the remittances and the direct investments. until we look at the whole range of resources available to development, we and we did we tend act as individual actors in our lakes. there was a time when it the world bank could do nice, neat projects without talking to anyone else. we need to do we need all those assets available.

it gets down to the issue of focus. -- we need to get to all those assets available. if your focus is on women in those farms, that is the metrics by which you are judging your success. you are looking at nutritional outcomes. and you need to have that degree -- to achieve those results, will be multi-faceted and multi-institutional. it will require private investments. -- remittances and brought investment. the broader remittance question is we need to look at ways to shift remittances more and to projects, and this is the challenge for the developing world, those resources will not be flowing to the local government many times. they will be flowing through local civil society and they

need to be seen as part and parcel of your development program manager solution on the ground. >> thank you. the question about effective engagement. >> i had time to right thoughts. -- to write thoughts. on the african diaspora, we will follow up with you. it is a dynamic part of the community. we found in various areas, that they add a tremendous amount. we have done a lot of work of how you cut costs of remittances, so you do not lose a lot in transmission. as he said, a lot depends on how you want to use funds. this is where we can help. it may be do you want to use of bonds with a civil society community developing in countries. maybe you want to invest in something. one of the things we're trying to -- trying to do ifthrough if.

we have a new asset management corp.. there will be putting about $500 million into sub-sahara africa. on the food security question, i would like to echo what joe said said about thanking president obama. -- josette said about thanking president obama. just in practical terms, by the end of the year, we will have a trust fund under these governance rules put together starting at about $1.50 billion and this will be new money from the u.s., canada and spain. the european commission is adding funds as well. there's a question about russia -- a great development is deputy prime minister and russia is coming back into the foreign assistance process, including things on agriculture.

one of the opportunities is about 9% of the -- 90% of malnutrition is in 36 countries. you need to of all the focus. some debt -- sub-sahara africa, it is also south asia. half the children in india do not get enough food. people in and -- in this country tend to see india and china as a new emerging powers. you get out of the cities, and you see there is poverty there. one of the things i would urge, since you're from the state department, one of the challenges we always have is there is an understandable drive for donors to do things by laterally. one of the issues i know talking to the u.s. government, if you want to be more effective, if we can try to have multi-lateral

improvement, we can do it with other players, we avoid this problem -- the donors get overwhelmed in the process. there is a quick question on the oil and food. oil prices went up, food prices went up. oil prices came down. food prices were stickier. oil prices have -- have started to come back up. i think you'll start to see the fuel-food interconnection remain quite close. then there was the question of does this threaten russia and the u.s.? if i were in russia, and i were looking at central asian, about 40% of the gdp depends on remittances, i would be concerned about the overall conditions of nutrition and development, because if there are problems on your border, it will come over the border.

similarly, for the united states, you have issues with central america, which again, the u.s. always ignores central america until the problem gets terrible. it would make a little bit of sense, whether b democracy issues -- whether it be democracy issues, millennium accounts -- if you think mexico is pushing our co-traffickers away. where do think it will go? they will go to central america -- the narco-traffickers. if you are in europe, i would be concerned about that -- the mediterranean. part of this is opportunity. we hope, coming out of the financial crisis, were well sources of growth, from? we are talking about 1 billion hungry people. we are talking about kids who do not get nutrition.

what capabilities, inventions, possibilities might those people bring? i do not only look at the risks. >> i apologize. we have come to the end of our allotted time. if any of the panelists would like 30 seconds for any last word? >> if i could -- i want to emphasize the nutrition point and demonstrate one last synergy. this is a product we developed in india made with local produce. it is a power-packed sweet much like, humus. a parent can rip off the corner, squeeze this into a child's mouth and it will give them all the nutrition they need. made with local produce. you do not need to add water or

it does not need to be refrigerated. there are no nutritional services to the bottom billion. there are no tools that a parent can buy in a drought or flood to make sure their kids getting of nutrition. i was in the philippines, 7 million people displaced, and there is no product that does not get -- that -- that does not need water. all the water is compromise. for scientists in the development -- developing word, to develop the next generation, that takes nutrition technology and connects it to the bottom billion. this is ultimately win-win. it is a business matter when people have to eat. if you can get this investment, the logic right, you can help. >> are you ready to be out of business?

>> i would love to be out of business. i do not see it happening. the key is that any food production is tied to the environment and ultimately to environmental sustainability. that environment is changing. our ability to look at adaptation issues around climate change and try to the broader food security challenge is a longer-term challenge that is not going away. the question is what approaches to agriculture and production are we putting it in place? to what extent are they sustainable and local environment? the challenge there is often a large-scale approaches may not be as sustainable, given the changing global environment. this is another notch to us to eve all our thinking, to look and -- to evolve our thinking to sustainable resources. it requires a greater investment

now. >> i know brookings has the foreign policy as well as the economic and the development side. maybe this is a question for your foreign policy colleagues. they do work on ideas about the effectiveness of the un and reports on the u.n. security council. my question is, how copmme -- in the un peacekeeping there is assessment? but there is no assessment for un food programs? >> please join me in thanking our panelists. [applause]

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arrivals starting at 9:00 eastern, here on c-span. >> thanksgiving day on c-span, bill clinton is on hand to% steven spielberg with this year's liberty medal. stanley greenberg, part of a panel assessing the obama presidency. and nick burns and lesley gell terrorism and nuclear weapons. later, howard dean and armey on the economy and capitalism. thanksgiving day on c-span. >> american icons -- three nights of documentaries on the iconic homes of the three branches of american government. beginning thursday night, "supreme court -- home to america's highest court," reveals the highest court to the eyes of the supreme court

justices. then the white house. our visit shows the grand public places as well as a rarely seen spaces. sunday at 8:00 p.m. eastern, the capital. the history, art and architecture of one of america's most symbolic structures. three nights -- thursday, friday, sunday at 8:00 p.m. eastern. get your own copy, a three-disc dcd said. -- dvd said. order online at c-span.org/st ore. >> a house committee held a hearing last month for -- to discuss a head injuries suffered by the nfl and the help they received. they testified before the house judiciary committee. it runs two hours, 45 minutes. >> we will come to order.

everyone who plays football knows it is a dangerous sport. everyone that watches it knows it is dangerous. it should be no surprise when a football player separates his shoulder, twists and ankle, busts and knee, -- busts a knee, but an increasing number of retired players have developed long-term memory and cognitive diseases, such as dementia, alzheimer's, depression and chronic traumatic encephalopathy -- cte. and it comes much later than after their careers end. sometimes, it is not even detected until the autopsies after they are dead. these are not the types of risks

most players or their families ordinarily associated with the game of football. as the national football league is a monopoly, by way of congressional sanction in 1970, whose existence was legislatively sanctions, the causes and pervasiveness of these football injuries warrant federal scrutiny. i say this not because of the impact of these injuries on the 2000 current players and 10,000 retirees associated with the football league and their families. i say it because of the effect on the millions of players at the college, high school and youth levels.

my 13-year-old son plays a game at 4:30 today. the questions before us are several. how serious is the problem? what can be done about it, and where do we go from here? there appears to be growing evidence that playing football may be linked to long-term brain damage. for example, a 2003 university of north carolina study found that professional players who suffered multiple concussions were three times more likely to suffer clinical depression then the general population. a follow-up study in 2005 showed

nfl players suffering concussions had five times the right of cognitive impairment. retired players were 37% more likely to suffer from alzheimer's than the population as a whole. earlier this year, the university of michigan released a study that found that 6.1% of nfl players over 50 years of age reported they had received a dimension-related diagnosis, a statistic five times higher than the national average. players aged 38 to 49 showed a rate of 1.9% of dementia- related diagnosis, 19 times and bad of the national average. -- that of the national average. last week "the new york times"

did an analysis of the data from the nfl's plan to reimburse retired players for dementia- related medical expenses, which found similar data. medical researchers also cite autopsies performed on numerous former nfl players, who, following their debt, were diagnosed to be suffering from brain disease -- following error death -- following their death. we remember mike webster, the pro bowl center from the pittsburg steelers who died regrettably a penniless reckless, sleeping on the floor of the pittsburg training station. . .

former safety, for the philadelphia eagles, who suffered from chronic pain and depression and -- later shot himself in the mouth. and today, dr. mckee will testify that former droil lions offensive lineman lou creek mer was toreanted so much that in his final years he lost the ability to speak and frequently ability to speak and frequently turn violent. lou is a player who is not the victim of multiple concussions and he reportedly never missed a game during his 10-year career. and the national football league is performing its own long-term study, and has -- has largely sought the -- to discredit these reports or some of the conclusions drawn from some of these reports. the football league described the -- the reports as flawed.

and dr. ire are cassen, the cochair of the nfl mild traumatic brain injury committee denied the linkage on six separate occasions. when asked whether there was any linkage between playing football and c.t.e., dr. cassen stated it has never been scientifically validly documented. and the league said that the recent university of michigan study was flawed. and that further study was necessary. and the new york -- the new york times data -- released last week, was -- they said, for

self-promotional and lobbying purposes, of the union. given, there's no consensus between the league and the players and the medical community about the causes of these cognitive disorders, it should come and no surprise that there is little agreement about how to respond. former players believe it is unconsheppable that the current disability plans only permit a full disability award for conditions developed within 15 years of retirement. such a limit, they argue, makes no sense for the diseases that frequently take more than 15 years to manifest themselves. player advocates also ask why there hasn't been more done to limit the likelihood of long-term brain injury. and for example, giving the players' association input in the selection of team doctors and trainers.

and -- and granting players unlimited access to their medical records. and requiring that all -- injuries be reported to the league and the players association. and limiting the frequency of full contact drills, to cite some of the -- of the possibilities that exist. the nfl responds it is set up and no fault compensation scheme paying ex-players with dementia up to $88,000 a year, and has instituted rule changes to the -- to limit serious injuries and develop standards for concussion management. and however, when it comes to making further changes in its disability plan, to account for long-term injuries, the -- the nfl asserts that that is a subject for collective

bargaining. the answer on how to resolve these differences and where we go from here, is -- is -- the realization that we need an expeditious independent review of the data and so i'm asking all parties and their personnel to make their -- their record available to us, to permit such review and analysis. of of the -- the request goes to nfl and nfl p.a. and relevant medical researchers ncaa and the national federation of state high school association. now when it comes to -- to public health issues, i do not believe it is adequate for the league or the players association to hide behind a collective bargaining agreement.

and sure liane $8 billion a year industry can find it within its budget to make sure players are adequately protected and that any victims of long-term brain disease are -- are fair my compensated. the seriousness are life and death issues. they go to to the heart of our nation's most popular sport and equally important, they affect millions of players of all ages and their families. i like now to invite our distinguished ranking minority member, lamar shot for his opening remarks. >> thank you. mr. chairman, the recently released university of michigan study of retired nfl players

indicates that overall retired professional football players are in fact in good health. and the "new york times" has sutted that this study also points to higher than normal rates of dementia or other memory related problems among former players. but the study does not support that view and prior studies have been argued to point both ways. and while we need to take this issue seriously, we should not jump to any conclusions. and as the lead author of the michigan study la stated, quote,, the study did not conclude that football causes dementia, end quote. high my publicized claims that the link is supported largely is a result of misreporting of the studies. they have drawn this to the "new york times" time attention. the author stressed they do not believe, quote, any responsible scientist would conclude from the study that retired football players had higher rates of dementia than any other group,

end quote which was alleged by the "new york times." and mr. charpe, i like -- i like unanimous consent to put a letter to the "new york times" from the -- >> without objection, ordered. >> and thank you. >> mr. chairman, the authors also underscore that, quote, the comparison study used for dementia understates the true rates in the american population. end quote. in your own words, according to the authors themselves the rates for retired layers are likely comparable to the american population in general. and so we need to be careful about what conclusions regarding dim men aer 0 memory problems we draw from the most recent look at retired players health. professional football is the most popular sport in america. it is important the league and the players make every effort to make pro football as safe as reasonably possible. the nfl should continue to study the potential long-term effects of head injuries on player

health. the league should also study whether equipment improvements or stricter rules enforcement could reduce long-term impacts of head injuries. and of course college and high school officials should do the same. congress should not attempt to influence the upcoming collective bargaining process, the nfl, and its players union are about to undertake. we should also avoid the temptation to legislate in this area. and football, like soccer, and rugby and even basketball and baseball involves contact that can produce injuries. we cannot eliminate regulation without eliminating the games themselves. and the retired player study concludes, the study finds retired players to be in good stead, overall. and their history of physical fitness shows up in lower rates of diabetes and cardioraz klar disease. playing in the nfl, was a positive experience for most retired players.

and congress can highlight the potential long-term consequences of playing professional football through hearings like this one. but the nfl does not need congress to referee this issue. while many would say we're fans of football, monday morning quarterbacking doesn't qualify us as experts. both teams are at the table here today, or we'll be -- will be shortly and we should work together to find a solution where both the players and the league win. and mr. chairman, i look forward to the witness' testimony and hope that this hearing will result, nee neither in expadge rating the problem of injuries nor in downplaying the need to look if ways to reduce injuries. in chairman. thank you. >> thank you very much mr. smith. and did jim brown -- of cleveland come in yet? out of the -- of the natural generosity of my heart, i'm

going to allow three people to make two minute statements. miss baldwin and mr. quigley and hank johnson. if you agree to that, you'll be recognized. so we'll start off with -- with tammy baldwin. >> thank you. >> i want to thank you for holding this important hearing, as well as extend my thanks to our many witnesses who have taken the time to be with us this morning. and i also want to acknowledge the presence of mr. willy wood, a retired nfl player from the green bay packers. as a proud packer fan, i will -- would like to boast for a moment about mr. woods. he made the all pro team nine times in his 12-year career and played in both super bowl number one in 1967 and super bowl number two the following year. and thanks in no small part to

mr. wood's impressive work as a starting free safety for the packers, green bay won both of those super bowls. he finished his 12 nfl seasons with 48 interception which is he returned for 699 yards and two touchdowns. and mr. wood was inducted into the pro football hall of fame in 1989. and mr. chairman, i know that wisconsin people and packer fans across the country are grateful to mr. woods for an incredible career. while we know what an outstanding player he was during his sheens with the nfl, i think there's less awareness of the hardships that players like mr. woods endure later this life because of a lack of health care coverage. mr. wood is currently living in an assisted care facility and his nhl pension of a little over $1100 a month is not enough to pay his bills. all though he hat beneficiary of when is known as the 88-man these funds are often not enough

to cover izz his monthly medical care. so mr. woods relies on the charity of others. these situations are not uncommon among former nfl players suffering from disabilities and dementia. >> we have lots of questions and that's why we're having this hearing today. i look forward to learning more about the issue from our expert witnesses. and mr. chairman, do i ask unanimous cannot sent to to submit for the record, an article called offensive play in the new yorker. >> we would be happy to >> we would be happy to introduce that into the record. >> think you. i will make several points. number one, i appreciate the serving. i am surprised it takes precedence over as reconsidering the major elements of the patriot act, which has to be determined in our effort on the war on terror before they expire.

secondly, i must die i had the good fortune of getting to kn ow john mackey and tessin the deterioration of the great man, a leader in the nfl and the players. believe that investigation of the kind of injury suffered in the nfl and other levels of football is appropriate. third, i hope that beyond everything we are dealing with here that the greatest thing that can come out of this is serious studies as to the impacts of the use of equipment, at the head as a weapon in football, and the rules to protect players that will not only affect the nfl, college, and high school as well. too often i hear on television commentators talking about the great hit. it is a hit often used with the

head or not been enforced rule against head hits, both on the pro and college and high-school level. if there is any one thing we can do, it would be to show it is not a game to destroy people's brains with respect to the misuse of held myths and misuse of the head of drinkable. i love football. i happen to go to notre dame. i know a good number of guys who played in the nfl, but we need to face facts. a ball is a great game, using the head in the way it has developed -- people understand, you do not have to worry about breaking teeth or jaws, the helmet encasing the head allows players to believe they are in vulnerable because they cannot see the entry. -- because they cannot see the injury. thank you.

mike quigley of -- illinois. thank you, mr. chairman. let me focus this on a broader scale, if our concern is that perhaps we should be dealing with the patriot act, patriot act or other matters, perhaps of greater importance, let me try to put it on a broader scale, the nfl is the role model for high school players. and you know, it is important to understand that the extent of the risk the athletes take when they step on the field each week and it is natural to center our attention on the professionals who will fill our sunday afternoons. but, i think it is absolutely critical that in addition it focusing on the athletes who play in front of seasoned ticket holders, that we remember the ones that play in front of their family and friends and peers on friday nights. and the norms of the nfl for better or worse, become the norms of high school football

players. and while contact and collision are inherent to the game, so too is certain code that comes with the game. that you go back to the huddle, no matter how badly you're hurt. that you play no -- no matter how badly you're hurt that full contact drills all of the time are okay. and that you don't need water, and -- sufficient basis when you prepare. what i'm getting to here, is -- whatever we traci and deal with in the nfl, goes beyond the concerns that we have -- with nfl players. and it goes to those young people who play on friday nights, and throughout our country. and while we can't do everything, to change the dangerous nature of the game, we want to insure that the nfl is doing everything in its power, not only to provide for the well-being of its players, but to set the right example for the millions of high school football players, who follow their lead. and very, very few of them will become nfl players.

but they -- they still can be hurt and have long lasting injuries as a result of their play. and what they -- they follow on sunday afternoon. and so i hope that one of the benefits of today's discussion is that, there's a launching point to broaden the discussion on what can be done to increase player safety at all levels. thank you. >> thank you. daryl ice of california. >> thank you, mr. chairman and as a member of the committee and the member on steroids next door, i want to thank you for taking up the issue. i believe that when government oversight and reform began looking at steroids, with a -- a bent toward a union negotiation that had failed, i believe that we -- we didn't realize at that time that we could be as successful as we were in getting base -- professional baseball to get steroids out and to have testing and for that to fall down into college and high

school ball, where today i believe we have done a better job of eliminating that on our young athletes. i believe at best, that's what we're going to do here. we're going to cause the ongoing union negotiations to focus on prevention, on dealing with, with the changes in officiating and we're obviously going to -- to see behind closed doors, the nfl deal with the question of how much do you pay upfront and how much do you hold pack for the long-term care of athletes. and i believe that it is appropriate that we in the judge that -- those negotiations. and because ultimately, there's only so many dollars and those dollars have to be allocated by -- by a form of negotiation in which we're not participants. but when it comes to -- to changes in the -- in the tolerance at professional and -- and college yet levels of -- of,

if you will head butting and other -- other techniques that are growing and growing in their use and as a result leading to -- unnecessary head injuries, i think your leadership will be long appreciated, for the fact that -- if we make it an issue here in congress, it becomes an issue at the bargaining table, and it ultimately will make a difference in the next u.s.c. notre dame game which means a lot to my colleague and i'm sure to all of us. i thank you and yield back. >> thank you so much. last one on our side, last one on our side is hank johnson and the other side is bob goodlab. >> hank johnson of atlanta. >> thank you for holding this important hearing. i'm glad this committee has taken an opportunity to look at how football and head injuries has the potential to affect one's quality of life. and today we will hear testimony from several witnesses who will

discuss the necessity of independent research as well as the importance of incorporating any findings linking concussion and conknitive damage into -- into preventive racquets. failing to have research that is independent could easily miss lead the public into underestimating the serious impact of football head injuries. and in the long run, the old mantra of perseverance has the dangerous trickle down effect of influencing, over a million children who play high school football, and -- the thousands who play, play, and a thousand, that are injury idea every year. walking off the pain as it is called, in an nfl game turns into, walking it off, in a little league game. as young children often

encouraged by parents and coaches, attempt to imitate what they view as the noble behavior of their football heroes. and gladiators. and this behavior is clearly dangerous and a reu.s.al to recognize and respond to the danger is -- reckless, and irresponsible. not only are the direct impacts of these head injuries dangerous, the trickle down effects on high school and college players are very real and can be fatal, as we will hear today. i look forward to hearing the witness' testimony, and -- on this very important and urgent necessity. to -- to, to -- to conduct an independent study on the cog knitive impact of football head injuries, and the legal ramifications of this brain damage. i think the chairman again for allowing me to make an opening. and you go back to balance of my

time. >> thank you. >> and senior member of the judiciary committee from virginia, bob goodlat. scry want to take the opportunity to welcome ticky barber, a star of the giants now retired who hails from my hometown of roanoke, virginia and who will be testifying on the second panel i believe and can share a lot with us. he and his brother rondy not only were great stars in the nfl but also, at the university of virginia and -- prior to that, in -- in the city of roanoke in -- in football played there. and -- and in high school. and so they could share this perspective with us, at each level of competition. and i also -- want to note that the great work that he has done in promoting football and -- recreation and athletics in general. he and his brother have -- have

sponsored camps and other activities and i have seen first hand their great passion for -- for our young people. and i also want to associate myself with the remarks of the gentleman from california and -- as well, the ranking member. i share the concern about some of the practices that take place in football and i think this is a great opportunity for us to learn more. and to shine a spotlight on this issue, but i also associate myselfs with the remarks of mr. smith, in saying that -- while we did want to pay close attention to what is going on here, i do not think the congress should inject itself into the negotiations between the nfl and its players and nor do i think that -- that as some have proposed here in the congress, the congress should engage in -- in legislation that would allow or prohibit certain types of plays from taking place and in high school or college or -- or -- major league athletics,

quite frankly, that is something that -- should be left to other people who are in better places in better positions around the country to make those decidings. and we here, the amateur quarterbacks on the house judiciary committee should not take up -- that kind of micro management of american athletics. i thank you, mr. chairman for -- for having this hearing and allowing us to learn more about the issue. >> of course we would never do anything like that. we have a -- a distinguished member of congress -- the -- the founder and chair of the congressional brain injury task force, and bill pass cell, he's been at all of our hearings, and we sometimes thinks he's a member of the judiciary committee. we like him to begin this

discussion today. we welcome you back again to the committee, mr. paskarel. all of the members with an opening statement, we'll take it into the record and welcome you again. before us. >> thank you, chairman coniers and ranking member smith, members of the committee for having me here to speak on a very important topic of brain injury, it has become part of my life. literally. mr. chairman you did a great job in bringing together a wide array of experts to discuss what can be a difficult and very controversial topic. and these wounds play be invisible but the consequences are very real. you have taken a stand to insure that these consequences are addressed. as cofounder and cochair of the congressional brain injury task

force which is comprised of over 130 congressional members from both sides of the aisle. and since its founding in 2001, it is the task force mission to expand the understanding and public awareness of brain injury. mr. tcharme, mr. ranking member, educating members and the general population, has been the most difficult effort of this task force. and in recent years, the task force has taken a greater focus on brain injuries that have become the signature injury of the iraq and afghanistan war. and it is estimated that as many as 20% of soldiers returning from iraq and afghanistan have sustained a brain injury. and the brain injuries of our soldiers have spurred congress to make unprecedented investments in brain injury

research. research that will benefit soldiers, and civilians alike for years to come, and we have done this in a bipartisan fashion. and the same way that we gained greater understanding and research from the brain injuries of our soldiers, we should also take this opportunity to learn from the injurys of professional athletes. the task force placed considerable attention on issue of, so called mild brain injuries. and specifically on -- on concussions, which aif he can everyone from our soldiers in the battlefield to our children who play on various sports who play on various sports in fact, the task force held a panel discussion that featured two of your witnesses today. dr. tucker who is the team

physician of the baltimore ravens, mr. no would servitzi. these discussions and the growing numbers of studies like the one commission that the national football league opened our eyes to the implication of that injury. unfortunately, these consequences hit close to home. on october 16, 2008, write and direct tryan dorehyrty tragicald without fully recover in from the concession -- concussion that happened earlier in the season. in a later panel, you will hear a story of the untimely death of another young athlete, will benson.

please listen carefully so that we can work together and do something about preventing these things from happening. these stories are not unique to these young men. according to the centers for disease control and prevention, as many as 3.8 million concussions related to sports and recreation are estimated to occur each year. after sustaining one concussion, an athlete becomes as much as four to six times more likely to sustain a second concession. i also want to point out that recent study shows that girls may be at higher risk court concussions and based blogger recovery times. clearly this is a problem that can impact all children. startling to see the numbers within a sport that we usually don't associate with, with problems of brain injury,

and soccer, and -- there are -- i have never seen a soccer game within anybody wearing any kind of protective headgear. and i want to point out that recent studies show that girls play be at higher risk, i repeat that, because study after study shows this. and this is not something that is picked off a shelf. these are siving studies. and a recent study from the center for injury research and policy at nationwide children's hospital, if -- in columbus, ohio, also foun that as many as 41% of concussions, high school and the heats play be returning to play too soon. and i would suspect that when we look at this further, when the nfl does its studies, that that will be centerpiece for whatever we're going to do in the future. and many colleges of professional athletic associations, including the nfl,

have all adopted guidelines for the management of concussion. however,, much of this information has not been -- has not made its way to our local middle schools or high school. i think that's imperative. this is serious business, when you see how many of these concussions are taking place and how many children are injeopardy of losing their lives. and in response to the growing problem, last november, i introduced the concussion treatment and care tools act, better known as the contact act, with todd plats who is the leading republican in the task force, he's -- cochair with me. and early in 2010, we expect that this bill will be heard. the contact act is designed to provide our schools and coaches with the tools they need to insure that student athletes receive the proper care for concussions, regardless of the sport that they play.

because varied and conflicting concussion management guidelines, have caused confusion, the contact act provides for the establishment of a consensus, set of guidelines that work for schools by bringing together a wide range of experts. and this bill also incentives the adoption of guidelines by scoose to insure that student and the lees receive the proper care and are given adequate time to recuperate before they are returned to play. and need i say that it doesn't matter how young or how old you are, or what sports you play, or whether you play professional football, this should be a guiding principle of our research. and 2006, i worked at the brain injury association of new jersey, to provide grants to new jersey schools, for the purchase of these technologies.

and that are available, the contact act provides funds for the adoption of these technologies and our nation's middle and high schools. and if we're seeking the kinds of tangible, long-term consequences of brain injuries, as revealed by recent studies of nfl players, you have state-of-the-art equipment and access to the best care available, then we have to consider what this means for our young athletes. and because damage to a maturing brain can be catastrophic, it is even more important to insure that we understand these consequences and that the proper care is provided to young athletes. i'm happy to report this morning, i just received it, that -- that both the national football league and the national football league players' association have endorsed the contact act. and the letter is before me.

and -- and if anyone cares to read it. >> we'll accept it into the record. >> thank you. >> and we're encouraging young people and i'll be closing. >> and to be healthy athletes. and they embrace ideas like and doing their pest. in this congress, must do everything it can to protect them, as they participate in sports. and that is what we call fair play. it is my hope that this hearing will generate a national conversation, spur innovation and equipment, and lead to action regarding brain injury, in the implications that these findings have, for and the heats of all ages, male and female, in all sports. and i thank you again mr. chairman, mr. ranking member, for holding this important hearing and i would fladly answer any questions if there are any. >> there are plenty, but we're not going to go into it today but we do welcome your -- e your coming with a -- with us again,

and the work that you and your caucus is doing in this regard. so, we thank you so much bill, for kicking us off. >> thank you. >> the first panel consists of merril hodge and george martin and david david greer and robert cantu and dr. andrew tucker and dr. gay colverhouse and mr. smith and the commissioner, of the national football league, roger goodell. we welcome you all. and urge you to take your seats. and -- the current commissioner of the national football league is also

the son of senator charles goodell, wo was both a member of congress and a united states senator. roger goodell played football himself in college. and he's -- been with the -- with the -- with the national football league for many years. . . we invite you to begin the discussion. we welcome you all. >> thank you, mr. chairman. members of the committee, i submitted a full statement and

would ask that to be included in your record. since becoming commissioner of the national football league of little more than three years, i can think of no issue to which i have devoted more time and attention to the health and well-being of the nfl players, and particularly our retired players. i want to review " we have done -- i want to review what we have done in the past three years since i became commissioner, we have made a wide range of improvements in the benefits and administration of the disability plan. we have lengthened the time in which players can apply for benefits. we have obtained a new independent medical director. we obtained a new independent director. we have simplified the process for applicants and their families. each of these changes was made at our initiative.

as we proceed did -- preceded the current round of collective bargaining, we look for to current improvements in the plan. with a plan that provides a $88,000 for each former player and his family to as dementia or alzheimer's. those players do not need to show that their condition is related to football. we have developed and funded new bethel benefits for retirees, including cardiovascular and profit -- prostate cancer screening, assisted living are arrangements, and discounts for prescription drugs. retirements -- retirees are eligible at no cost to themselves. in each successive collective bargaining since 1983, we have improved this and we want that to continue. as we negotiate for a new agreement, the clubs have identified specific priorities and we look forward to discussing the proposals with

the union. through these and other benefits, retired players will receive more than $100 million in 2009, and i have committed to our retirees and our repeat that commitment today that we will not reduce or eliminate funding for these benefits based on the status of our collective bargaining agreement, and we will continue to accept new applications for disability for 88 plan benefits. with also tried to understand the need for our retirees and their families. i've met with hundreds of them across the country. we had a phone survey which dr. weir will discuss. we are actively follow up with the 56 players to report may a look -- memory problems. we know that concussions are a serious matter and that they will require special attention and treatment. i have been clearer, medical considerations must always come

first. decisions regarding treatment of players with concussions and when they can resume play must be made by doctors and doctors alone. we are changing the culture of our game for the better. again, it is important to look at what we have done. in addition to research that has led to better equipment, we have made numerous changes in tactics that lead to concussions. we took a number of steps with the active participation of the medical director spirit we held an open medical conference on concussion. many of the doctors here participated and share their findings. we develop new educational material for families and their players -- players and their families. it reinforces a clear trend toward increasingly conservative care. the nflpa and i jointly

communicated these initiatives to our coaches, doctors, and trainers, and the reports were widely publicized. we look for to continuing collaboration. i met with dr. cantu in boston. bake in a discussion, i have asked john mackey, a special adviser to me, to work with a group of coaches to identify new practice techniques that have been used in the past reduce the risk of head trauma outside of the games themselves. we must continue to work from and base our decisions on science. but we cannot stand by why research continues. we will continue to have a singular focus on player safety and do all that we can do equipment roles -- equipment changes, rules, education and medical care to make the game as safe as possible. we will also support all manner of ongoing research.

one outcome of my discussion with dr. cantu is that i expect to announce nfl research into cte. we understand that our example extends to young athletes. we of the street and material on concussions development -- developed by the cdc to 9000 youth programs across the country. and the nfl web site visited by some many people contains a wealth of information about concussions and other health and safety issues. we will continue to do more to disseminate information and to emphasize safe and fair play. in conclusion, mr. chairman, our goal is continue to make our game as safe as possible for th >> thank you very much, mr. commissioner. the next witness did his thing

and varsity track and field, went on to law school, university of virginia law school, worked in the u.s. attorney's office, served under eric holder when he was deputy attorney general, a trial lawyer, was president of the assisted united states us attorneys association and has received many awards. we welcome you. we have your statement. we encourage you to expand on it and the tide you have. >> yes, sir. good morning, mr. chairman. members of congress and others, thank you for the opportunity to testify this morning. i would also like to take the

time to welcome silvia maquis who -- silvia mackey, wife of john mackey. as executive director, number one priority is to protect those who played this game. there is no interest > their health and safety. let me say this again, the safety of our players is paramount. mr. chairman, you and the committee deserves immense credit and appreciation for consistently bringing this issue of concussions, brain trauma, health and safety in the sport of football to the forefront. this committee and this hearing will be a turning point of this issue. my hope is that this day will serve as a marker to noting the day that we are committing ourselves to a finding the right answer.

it will influence not only this game at a professional level, but the one that so many of us love for our players in college, high school, and in useful fall. -- and in used football. -- and in youth football. answers, to work with everyone who has the goal of protecting our players, and to serve as a model for football at every level. given that commitment, i acknowledge that the players union in the past has not done its best. we will do better. to men like john mackey and brent boyd, to men like mr., and the families like mike webster and underwater, and to those organizations that stand with us, i commit and we commit this

is our primary mission. we will not fail them. i will not fail them. but myself and the current and retired players of the national football league are committed to getting this right. i was elected by the board of player representatives in march of this year. since that time we've taken the following steps to address this issue. in may 2009, we created the nfl players concussion and traumatic brain injury committee. it addressed two critical issues -- that diagnosis, treatment, and prevention of concussions and tv guide and active players, and the long term, cumulative effects of tv guide in nfl players -- and tbi in active players. how these conditions can be reduced for eliminated.

this committee will act as a superconductor of current and future studies and is charged -- to get the right -- to get the answer right. two weeks ago, i met with all the chapter presidents and steering committee members who represent the retired players of the national football league. this 40-person congress of former players that represent and make up the nfl retired players association is an organization with over 25 years of history. at that meeting, they all embrace the creation of this committee. they join our call to have the national football league release all aggregate medical information that has been collected over the years to benefit both current and retired players. third, several players have dedicated their bodies to medical science in the effort to provide researchers with the best informations, to aid those

that will play this game in the future. this body of retired players also had several players who were willing to do the same thing. not only to help the players who are playing this game today, but as they have done in the past, to stand up for the people who will play this game tomorrow, because they know that it will be their sons, it will be their daughters who are playing sports that will benefit from this research. for the first time ever, the players association's medical director is present at every meeting, including collective bargaining meetings that deal with player health and safety. he will chair the players tbi committee. finally, mr. chairman, to everyone here, to the retired players, to those who are watching us across the country, the players of the national football league will not bargain for medical care.

we will not bargain for health and safety. we will not bargain for basic provisions of the law as patients. we will continue to work with the leak, but medical care is not and will never be just a collective bargaining issue. while all players understand the professional football is a violent game, we must do our best to keep them informed of the games potential consequences. yes, it is true the professional football players are the best, most well conditioned athletes in the world, but even those blessed with tremendous athletic gifts are vulnerable to severe injuries. we must know and embrace all of the medical data to prevent, treat, and manage the long- lasting effects of these injuries. mr. chairman, i welcome any questions, and am prepared to submit any other in affirmation you may request, and happy to be

here today. >> thank you, attorneys met. our next witness is the daughter of the late hugh culverhouse, the owner of the tampa bay buccaneers. dr. gay culverhouse, she has an inmate and a doctorate in education from teachers college, columbia university. while her father was on of the buccaneers she served in administrative roles within the team and eventually became its president. she is in the process of concluding her work on a book entitled "violence -- the underbelly of the national football league," which was prompted by learning about the deteriorating health of her former players who serve for

from concussions. -- who suffered from concussions. she has received many degrees and honors and i am very happy to have her here before us today. welcome. dollars hit the button. -- hit the button. >> thank you, mr. chairman, and thank you, committee, for giving me the opportunity to address you today. >> pull it closer. >> i will just deal. -- yell. my father was awarded the national football league expansion team. from that point on, i have been intimately involved ago. the years i was at the university of florida, steve spurrier was the heisman trophy award winner. i am the grandmother of six

children feele these people's grandmothers here, because i had been involved in football for so long. the one thing that i would bring to your attention that i think that i have a unique perspective on his -- mr. goodell spoke to the medical aspects and letting the doctors make this decision. one of the things that you as a committee need to understand very clearly is that the team doctor is hired by the coach and paid by the front office. this team doctor is not a medical advocate for the players. this team doctors role is to get that player back on the field. even if that means injecting the player on the field. i have seen a wall of players surround a player and seen his knees injected. sees his hip injected, and him back on the field.

this is inexcusable. i want you to understand the role that the medical community has and facilitating these concussions. the players get to a point where they refuse to tell the team doctor that they have suffered a concussion as well. they do not report because there is a back-up player sitting on the bench ready to take the position. most of their contracts are back and loaded with performance bonuses. they need those extra yards and those interceptions in order to make their salaries. the team doctor goes over the medical records and helps the team coach choose the incoming players or the next season. he is involved in the draft

process. he evaluates how severe that knee injury was in college. or that concussion. he is part of the selection process. so he has a very vested interest in that players success on the field. the team doctor dresses as a coach on the sidelines. he? in many ways as a coach on the sidelines. he is not an independent advocate for the player. if a player chooses independent medical council, he is considered to be "not" a team player. it becomes a pariah to the team. we have got to stop that. we also need to have, at every game, an independent neurologist or near research and on the sidelines neurosurgeon on the

sidelines, who is not prejudiced. who is independent, who could make an independent judgment if he sees a player in the huddle throwing up. something needs to be done about this medical care. you cannot leave it and hands of the team physician to make these decisions. and the players are at the point now where they will not support -- self report, because they need the money. they are disposable commodity. there is a draft coming up every april. these players fight to hold onto their jobs and a welcome shots and anything else that will keep them on the field.

this is in my idea inhumane and i watched it since the early 1970's. and i will tell you that it has not changed. do not be fooled that since i left the game in 1994 that this game has changed. you can see the discussions on whether to empty bow -- time tiboe should play. my grandson is 10 years old. tim tibow is his idol. you better believe that tim will rush back out there to play. we need a medical doctor on the sideline to tell my grandson know. -- to tell my grandson no. >> thank you very much. dr. andrew tucker, medical

director in baltimore, 15 years experience providing primary medical care to professional, collegiate, scholastic, and recreational athletes. head team physician for the doll -- for the baltimore ravens. he serves on a number of the advisory committees. he is focused on the performance enhancing agents, mile traumatic brain injury, and cardiovascular health. health. and as i understand he has written chapters on various subjects, sport health topics including discussions -- including concessions.

-- concussions. dr. tucker, we are pleased that you could be with us today. >> thank you, mr. chairman. i will correct one piece of information, i am past president. immediate past president. i have been a team positioned in the nfl since 1991. -- i have been at team position in the nfl since 1991. i have seen positive changes in the science related to the nfl. i would like to summarize for these -- these for you now. in 1994, when the commissioner requested that a committee be formed to discuss what was the lone and discuss every facet of the injury as it related to football it revealed a stark reality, we did not have much

scientific data on sports- related concussions. evaluation and treatment guidelines were well intentioned but not based on that science. manufacturers told us that their products had not changed in many years. there was no stimulus for innovation to decrease the risk of concussions. the first several years at the committee activity concentrated on understanding the basic epidemiology of the injury. that continues today. in parallel work, the committee enlisted the help of highly respected people from academic communities in the united states and canada to study concussions in new and innovative ways. game video tape was studied and analyzed. researchers were able to create reconstructions of collisions

that accurately represented what was happening to players on the field. . . represented what was happening to players on the field. this had never been done before. research breakthroughs resulted in tangible benefits. helmet design -- the affirmation that we have shared with manufacturers was a critical manufacturers was a critical stimulus to the first es in helmet design in many years and provides us with optimism that the risk of concussion in players at all levels -- not elimination, but the risk -- might be freeze with these improved designs. secondly, helmut testing. because we have a ballot laboratory protocol for recreating the conditions that result in concussions on the field, this laboratory set up can be used to evaluate the new products that i just spoke about. thirdly, the interaction with

nocsae. it is the committee that establishes safety standards for sports equipment including helmets. the same elements that are children wear. it allowed us to understand that the speeds and forces associated with injury and concussion in the nfl were different from what they were using to test helmets. bus are open dialogue has resulted in modifications in how helmets are tested for efficacy. as the commissioner reminded us, rule changes. a greater understanding of how concussions occur on the field has been shared with the national football league and provides the competition committee with valuable objective give permission to make rule changes to protect players and make the game safer. a lot like also to take a couple of moments to talk about neuropsychological testing and the study of retired players. the testing has been utilized in

the study of neurological patients for over half a century. our colleagues in pittsburgh and other academic centers were leaders in developing the testing for the evaluation of brain injury since the early 1990's. the task has evolved as a valid and reviled -- about evaluation and management tool for sports related concussion. our committee was instrumental in supporting the use of this technology across all nfl teams in the mid to late 1990's. its use is now mandated for all nfl clubs. it was also mr. mill in promoting the use of the evaluation and treatment of athletes at all levels of competition. retired players -- the study of retired players remains the most concentrated focus of our activities to date. while other researchers have published findings from survey and questionnaire data that suggest that corporate concussions may increase the risk for chronic changes in brain functions in retired players, our committee has noted

this and regarded as voluble and concerning and not yet definitive. these are due to limitations in research methods which will be spoken about. the committee is supervising a study of retired players that a ball -- that involves a control group of men who played college football in order to more definitely ascertain whether playing professional football is associated with increased risk of brain function in the retired athletes. the issue of chronic traumatic encephalopathy -- the players -- the issue will be debated inside and outside our committee. some experts believe autopsy findings of former football players are due solely to the effects of trauma, while other experts feel repetitive concussions are only a piece of the puzzle of a very complicated issue. the committee has hosted scientific exchanges on this topic as recently as may.

we will let another meeting next month. lastly, education. education of our own medical staff and players has been a priority of our committee since its inception. the first educational symposium was soon after the committee started in the mid-1990s. the most recent was in chicago in 2007, and another is planned for 2010. ongoing concussion education is regularly all part of our scientific interchanges at the combine in indianapolis. we have shared our knowledge and experience with our colleagues in sports medicine tour by an annual nfl team physician meetings. clearly the last 15 years has been a time for import advances in concussion research and clinical care. while our committee has published 17 articles from our research, we hardly admit that we have all the answers. our charge remains overseeing quality research for the benefit

of our active and retired players, and to advance the science of sports related concussion. my last perspective is that of a team physician. there are many challenges to evaluating in treating concussions and athletes of all ages. while the injury is easy to diagnose in some cases, there are other situations which -- many and at the lead sustaining a concussion is difficult to diagnose. with concussion as with any medical issue, the medical staff is dependent on the at least giving us accurate information to help us make an accurate diagnosis and properly care for the player. team physicians an athlete traders have long observed two primary barriers to this important exchange pre-athlete has thought that being mildly concussed is simply part of the game and not important permission to share with the medical staff. secondly, athletes want to compete and they want to play. they tend not to give us information that might result in

restrictions to play. i feel strongly that not only in the nfl's but as well as in my high school and college athletes, these barriers of like a patient education and unconscious reluctance to share information are much less imposing now than they were 10 or 15 years ago. finally, as a team physician at all levels of competition, i evacuate and manage concussions differently today than i did 15 years ago. while we try to understand the potential effect of head injuries on our current retired players, i do not think it is wise to indict the care being provided today's players based on reports of players treated at a generation or more ago. i am truly optimistic that the care being rendered to these athletes will prove it very beneficial to the retired athletes of tomorrow. thank you, mr. chairman. >> dr. tucker, we thank you for your statement.

i'm not pleased to recognize dr. robert cantu, clinical professor of near roles -- your surgery -- euro surgery, author of over 300 scientific publications, including 21 books on your surgery -- neurosurgery, lots of chapters and peer reviewed papers and others of the light. he has served as associate editor of medicine and science. he is doing a lot of helping some self. -- health things himself. we will put this very expensive resume into the record. we're pleased and honored to have you here.

>> i thank you, sir. mr. chairman, members of the judiciary committee, i am honored to be here today and thank you for allowing me to provide this testimony. i am a neurosurgeon who spent the past 30 years of my career focusing on issues pertaining to sports related concussion. as the author of the first return to play guidelines after a football concussion nearly 30 years ago, i have been fortunate to be able to participate in the development of and be a co- author of numerous international and national nata and acsm return to play guidelines for athletes following concussion. we are here today because there is a growing awareness of the public health crisis we are facing due to long term consequences of football-related brain trauma.

over the past several years, there has been growing and convincing evidence that repetitive concussive and subconcussive blows to the head in nfl players lead to a progressive near a degenerative brain disease called chronic traumatic encephalopathy, cte. this judiciary committee hearing was scheduled soon after a newspaper report of the nfl- funded research study of 1063 former nfl players who were givinen a lead the taliban -- telephone survey which included items pertaining to whether they were diagnosed as having dementia or other memory related diseases. the survey found the incidence of memory related diseases and dementia to be 19 times the national average in the 30-49 year-old age group. this comes as no surprise to those of us at the center for

the study of dramatic and sat falloff of lead traumatic encephalopathy -- at the center for the study of dramatic and set a lot of the at boston university. was this survey and its findings accurate? i am sure that we will hear more of that shortly. unfortunately the diagnosis of dementia cannot be made on a phone survey and the term "memory-related diseases" is not a precise medical term. thus the study's design is highly flawed. but it has had the positive effect of increasing the public awareness of this important issue. i am not here to debate the merits of this study but to point out that we have in my opinion a serious public health problem today resulting from repetitive head trauma too often experienced by nfl players. but the problem is much bigger

than the nfl. it affects football players at all levels, including college, high school, and youth leagues. and it is not just football. it is also a sports at high risk of brain injury, hawker, soccer, lacrosse, among others, that is risk for cte. the brain does not know what caused it to be violently shaken inside the skull. a football helmet to helmet hit, a left hook to the jaw, a check against the boards, or even a blast injury in military combat. the response in all may be the conversion of a naturally occurring britain -- brain protein, tau a the law high hyperphosphorylated form that is toxic to nerve cells and their connections. while our research shows that this abnormal accumulation of

tau is widespread throughout the individuals -- throughout the brains of individuals with cte, is immediately concentrated in medial temporal lobe structures and thus leads to a clinical triad of recent memory failure, and extreme degrees dementia, depression, and lack of impulse control. all cte has been mostly reported in the world's literature in boxers, and for the longest period of time, over 80 years, nearly 20 cases and all i several years have been reported from individuals that formerly played in the nfl. in our group, we've recently reported a case of cte in a man who only played football at the college level. obviously some of these individuals have entered the nfl already within said that if not full blown cte. but the -- with a incipient, if

not full-blown, cte. now that we are aggressively looking for cte, there has been a 40% increase in recognized cases in the last two years alone and we believe that this is but the tip of the iceberg. thus, i believe we have a serious public health problem and a master under-appreciation of what head trauma, especially multiple head trauma, at both the said concussive and subconcussive levels, can lead to. there's no doubt that these injuries do lead to an incurable injuries do lead to an incurable neuro -- condition that can lead to full blown dementia. obviously, if any athlete who experiences head trauma experiences disease.

there are additional important factors that make some athletes more prone than others to develop cte. but the public health crisis is already here. we cannot whinnied any longer to make the changes to a pro -- we cannot wait any longer to make the changes to pro sports. blows to the head, as we have heard earlier, need to be minimized through rule and technique changes, especially in sports such as football. thank you. >> thank you very much. we now turn to go dr. david

weir, who is currently a research professor at the university of michigan's institute for social research, specializing in the research and measurement of health-related quality of life, the use of cost effectiveness measures in health policy, and medical decision making, the role of supplemental health insurance in the medicare population, and has had recent projects commissioned by the nfl player care foundation. he was awarded a prize for best paper in the journal of economic history twice. in 1984 and 1995. -- 1994 and 1995.

fellowship -- that albert p. sloan research fellowship. i assume that you're not connected with the university of michigan injury institute, recently formed there. all right. we welcome you. and we look for to your testimony. >> thank you, mr. chairman and members of the committee, for inviting me here today. the institute for social research at the university of michigan is committed to the use of social science survey research to serve the public interest and we are always ready to respond to you as representatives of the public interest. i appreciate the opportunity to set the record straight on our study on retired nfl players. faced with the aging of the u.s. population, we are all looking for policies and programs to serve the needs of people after a lifetime of hard work. this unique population of retired football players is an

intriguing place to look for challenges and solutions. our study had two broad goals. the first at the request of the nfl was to describe the population of retired players across a wide range of topics from marriage and family life to health to economic circumstances. in an environment of sensationalized press accounts, they sought some basic facts on which to create or improve programs to serve the needs of retired players. the second goal, at our suggestion, was to lay the foundation for future research that could follow on specific health problems or other areas of need. i am pleased to say that the nfl agrees with us that further research on the dementia issue is warranted and we are now actively planning that follow-up effort. our initial telephone survey found that retired professional football players are, to put it mildly, a diverse and fascinating group. on average they are highly accomplished, productive members

of their communities, churches, and families. they suffer from aches and pains in shoulders, knees, backs, and necks that make difficult activities that many of us take for granted. most are in comfortable financial services but many report having received bad financial bias somewhere along the way. most have health insurance and are able to get the health care they need. they are proud of their achievements and their time as professional athletes. for every such generalization there are individual exceptions. there are retired players in poverty or without health insurance. some do not particularly like the nfl. there are some who claim their knees do not hurt. this diversity is particularly true for the issue of cognitive impairment and dementia that is the focus of the hearing today. in our telephone interviews 96% of nfl retirees report that they do not have such problems. -- but 4% do, and in some cases the disability and the need is

profound. depending on the severity of the problems, which our study could not assess, those numbers may or may not indicate an elevated risk from a career playing football. we cannot draw a conclusion and no responsible scientist would do so. those who assert that the rates reported by former players definitively show a higher risk do so by greatly under estimating the extent of dementia and cognitive -- cognitive imperative -- impairment in the general population. i wish it was rare but it is not. it is a major public health challenge facing the country. the followup study will address the major limitations of the telephone study with regard to the measurement of dementia and cognitive impairment. it would utilize a design and methods similar to the ones that we've used in a much larger study known as the health and retirement study, which have had the privilege to direct at the university of michigan with funding from the national institute on aging. the methods and results of this approach to diagnosis of

impairment and dementia have been published in peer reviewed scientific journals. it is done in the home by trained professionals and does not require travel or visits to clinics that might exclude some participants. with respect to end of the jewels in the nfl study who did report a memory-related illness, it will be important to distinguish between the more severely disabling condition of dementia and the more common but less disabling mild cognitive impairment. the needs of these two groups are very different and we will assess the extent to which the 88 plan created by the lead in the players association is meeting those needs. with respect to individuals who did not report any memory- related illness, we will seek to determine whether there is any significant dementia or impairment in a sample of cases. by comparison to studies using the same methods in the general population, we will be of a say to what extent retired professional football players differ in their rates of impairment and dementia. i understand the intense interest in this issue and the

impatience to have definitive answers. i have many friends who are parents of teenage athletes and i know how much it worries them. we will not delay, but getting it right is more important than getting it fast. to those retired players who we will ask to participate in the next day to this research, i make the promise that we will protect your privacy and we will report the truth. thank you, mr. chairman. >> thank you very much, doctor. we appreciate that. our next witness is george martin, who is the national football league's all-time leader in touchdowns, and it goes on from there. for quite a long time here. are you still playing? >> no, sir. >> last year george martin

walked across the country to raise money for medical care for the first responders to the september 11, 2001 terrorist attack. he raised close to $3 million for the families. and just this month, he was elected to the executive director of the national football league alumni association. and we will put all of europe rsume -- we will put all of your rsuesume into the record 3 where." have you here. push the button. >> thank you, sir. chairman conyers, distinguished

members of the house judiciary committee, my fellow colleagues, commissioner roger goodell, an executive director demaurice smith, i sincerely consider my pressure -- my presence here to be a privilege and an honor. i have a respected platform on which to bring a rather alarming issue to light from an extremely unique perspective, and honored by the fact that i represent a constituency that will be observing the outcome of these hearings from more than casual perspective. therefore i applaud these proceedings as hopefully they will represent the impetus and serve as the catalyst to attack greater and more meaningful response to an ever-growing medical phenomenon. as executive director of the nfl association, the recent medical findings around and head trauma all in the nfl and concussions more specifically, though undoubtedly inconclusive, has sparked sharp debate and generated considerable interest within this industry. while we as conserve representatives of the alumni association finds alarming to

said elite, unlike my other esteemed colleagues today and with all due respect, i can -- i am the only one here they can give the direct and actual firsthand accounts of the violence and oftentimes interest aftermath of professional athletes, which in some cases least to it celebrated diminished physical and mental capacity, or fatal human collateral. as a former defensive lineman of the nfl for 14 years, i've had the unenviable experience of entering like in what is commonly referred to as the nfl charges. and unfortunately when violent tactical maneuver such as head slaps, forearm shiver is, clothesline tackles, and violent head butts were commonplace among all facets of the nfl, although most of been eliminated, the resulting severity of these combated interactions were oftentimes to trivialized and minimize by the powers that be, usually referred

to as getting your bell rung, getting your clock cleaned, all having cobwebs in your bonnet. why reference such antiquated and archaic references -- behavior that has long since been banned it from use -- banned from use in professional athletes? the answer is rather simple. though the practice of such brutality has been long vanished, the resulting delay the consequences remain present. today we knowledge that such blunt force trauma is inherently dangerous according to several recent studies, most notably the center for study of traumatic encephalopathy, cpas, of the boston university school of medicine. such incidents can perhaps lead to premature death among athletes. some -- the sum total of the medical inflation such as cte cannot be accurately measured merely by commissioning a study.

as the all encompassing illness adversely affects each and every family member that i have is to be associated with the victim of a patient, and i reluctantly illustrate his point by the train the confidence of a friend who over the years has meant the vote -- meant the world to me as a mentor and a business associate third after 10 years in the nfl, he retired seemingly to be the picture of hell. he diligently maintain our rigorous regiment of athletic activity, while playing competitive tennis for it least three days a week. he also maintained a healthy diet and the never very 5 pounds above or below his optimum way. he also owned restaurants. to say that he maintained an

active alaskan output had been an understatement. -- active lifestyle would have been understatement one fateful day after returning from a business trip, he simply forgot where he parked his car. upon sharing the story with his friends, we all had an amusing laugh at his expense and naively talk it up to a simple happenstance. he himself would say, george, i guess i got hit too many times in the head. this incident happened only two short years ago. within the span of 24 months, this once vibrant hyperactive individual has been reduced to a mill share up -- mere shell of his former self, confined to house arrest, and since further and further away from a dynamic personality that we always knew him to be. the shame, the embarrassment, the degradation are but the tip of the iceberg that he and his

family had endured each and every passing day. this unfortunate scenario brings an unfortunate refrain among many nfl alumni. if my presence here today and a very public the trail of this deeply confidential situation of my former teammates results in eliminating this particular catastrophic medical calamity, i will conclude that neither had been in vain. the general consensus among the general consensus among alumnae centers on prevention. so we will be significantly diminished through enhanced protective equipment. secondly, proper diagnosis and a federal medical treatment without laborious red tape that often times becomes a painful preclude that is discouraging and completely exacerbates an already dire situation.

thirdly, that such medical treatment does not result in catastrophic tsunami that undoubtedly wreaks financial havoc on the surviving family. finally, a more comprehensive study that should include a cross-section of alumni to more accurately determine the problem among retirees who may be predisposed to the insidious, debilitating medical situation. on behalf of the nfl alumni, we greatly appreciate this form in which to state our position on this vital matter. thank you, mr. chairman. >> i am glad you were here to tell the story. >> thank you, sir. >> merril hoge, formerly of the pittsburgh steelers, the 10th starting running back for six seasons. he set the team record for the

most interceptions by a running back, totaling 50 in 1980 to -- 1988, but he suffered his first concussion with the bears during the 1994 season at a game in kansas city. he was back playing five days later. but when he suffered his second concussion six weeks later, it ended his career. he had to relearn how to read. he sometimes got lost coming home from a restaurant that he had frequented for years.

he is now an analyst for espn -- an nfl analyst, and even sometimes things can trigger problems about concentration and so forth. we're very proud to have you with us. we realize because of time constraints, and we see the concurrence of the ranking member, to take you from the second panel and put you on the first panel. and we're very pleased that you are here to talk with us today. >> thank you, chairman conyers. i appreciate that. it is an honor to be here. as mentioned, i played eight years in the national football league. seven for the pittsburgh steelers and one for the chicago bears. the pride of my career, a series

of concussions cost my career and nearly took my life. after my second concussion, i was escorted into the training room right flat line. as part of their be resuscitated, i popped back up and the rest me to the emergency room where i lay in the icu for two days. for the first 24 hours, i could not recall my wife, my daughter, or my brother who were there at the time. i was confined at home for weeks and could not leave unless someone went with me. i had to learn how to read again, i would for depression, and these major symptoms took nearly two years to recover from. two things wrong -- went wrong for my first concussion on a monday night game in kansas city. first, i never saw neurological doctor. second of all, i was cleared five days later to play the game

of football by family practitioner. to the contrary testimony, i will say this. there has been significant changes in the national football league based on the nfl and the nflpa. what happened to me would not happen in the national football league today. that does not mean that we are all the way there. we are on our way. something is also extremely important. we should all understand and that is why we're here, the brain is the most vital and sensitive organ in our bodies. without it, we do not function. we do not operate. that is why and i will broaden the scope and ask that you help us establish a national standard three part of that national standard -- and this is where it can be somewhat of a call me and soothing approach to this -- the standard being that

a neurological part -- doctor is always a part of the evaluation of head trauma, someone trained for that. and within this national standard, a player does not return to play to their particular sport until they are a systematic -- a symptomatic for seven days after they have cleared. if we establish just those standards, with all football, we would have less tragic stories and we have to this point. as i brought the scope of further, let me include our youth programs. youth football from ages 6-14, we have over 3 million kids playing football. that is twice as many that exist in high school, college, or the nfl combine. we cannot forget them. the reason i am adamant about

that. i am a youth coach. i'm active in youth football and other sports. i am the head coach. i am the trainer. i am the equipment manager. i am the cheerleader. i am a psychologist. all in one, and especially in the early moments of injuries. my experience has truly help me in critical moments in these programs, but oftentimes i watch on the sidelines with uneducated parents dealing with our youth. is of great concern. within that standard, i have never been part of a program where there is a standard or protocol to head injuries. if we were better educated in that fashion, we would have less tragedies. i am asking you to help us with that. help us create better standards, better requirements, and better education, and that we do not

overreact, that we promote athletics, we promote activity. what -- one of the biggest concern is that we have in our youth today is obesity. the health care issues that exist with that. we cannot say, because of head trauma and concussions we must eliminate sports. we must educate and properly evaluate and properly take care of those athletes. if we do that and create safety, that will encourage more use to be involved in our sports, that we're properly taking care of them and educating them. . i have also met with demaurice smith many times.

my words have not fallen on deaf ears. he has been committed to helping this issue and our former players. may i address them for a second? they are the people we cannot forget. they are the ones who created a stage safe enough to play on. i was part of building a stage the current player build on. the current player is continually building the stage that future players will build on. too many times, the nfl and the nfl pa has made it too difficult on our retired players to get the proper care they deserve. being here today gives me great hope that we make bridge the gap, not only in this particular subject would brain trauma, but in the health care issue that exists in the nfl. commissioner conyers, thank you

for having me here. >> thank you, very much. i have three questions. and i am not a very sensitive person, but would you describe that uneducated parent with a little more spess fifty? >> chairman conyers, i absolutely would. i have a great example that happened a few weeks ago. it may have broadened the scope a bit from the uneducated parent to the uneducated coach who works on the sideline. i had a young kid named griffin who got up from a collision a little woozy. he had had some kind of head trauma. jake knows griffin. i wanted to address what was going on with griffin.

i wanted to address a lot of cognitive things i am aware of now, to his name to what play we just ran to find out where his senses were, looking at his pupils. then i asked jake to talk to him to make sure it didn't elevate. five minutes later he ran over and said griffin is ready to go back in. i said no, he is done playing. i just wanted to make sure his systems did not elevate. then i wanted the parents to monitor him and take him to the doctor if necessary. jake could very easley be a head coach in our youth program, and he was willing to put his own brother back on the football field purely out of ignorance. i probably would have done the same thing. that is why i think standards

in education would help with mistakes like that. >> my three questions are these. commissioner ghoul, -- goodell, is there a link between player professional football and the likelihood of contracting a brain-related injury such as dimension -- dementia, alzheimer's and others? my second question is commissioner goodell and executive director smith, will you agree today to open up your books, records, files so that we may conduct an independent examination concerning brain-related diseases? madam dr. culverhouse, how does

it make you feel to see your former players suffering from the repercussions of poor choices made to prematurely put players back into the game after injuries? >> chairman, let me address your first question. you are obviously seeing a lot of data and information that our committees and others have presented with respect to the linkage. the medical experts should be the ones to continue that debate. our bottom line is we are not waiting for that debate to continue. we want to make sure our game is safe, and we are doing everything we can for our players now. that is why we have encombaged in aggressively making changes to our game. we have done some of the things that have been discussed here on a variety of levels. let's start with the fact that we have made significant rule changes to our game. five rule changes this year alone have been made that i

think are improving the safety and welfare of our players. they have had a positive impact in the short term they have been in place, and we will continue, as we have done every year, to evaluate rule changes to make our game safer. many of those changes this year were specific to head injuries and making sure that we take certain techniques out of the game that can be unsafe for our players both in the short term and potentially in the long-term. we have also engaged aggressively on education. we have worked with the players association, with our medical doctors, to create information that we can share with our players and also with players at other levels. it is an important responsibility. >> well, you have testified to that. i just asked you a simple question. what is the answer? >> the answer is the medical experts are -- would know better than i would. we are not delaying anything

that we do. we are reinforcing our commitment to make sure we have the safest possible field. >> i have heard. dr. cantu? >> sir, in the world of literature, chronic inreceive lopeath is reported in boxers and reported at a younger age in boxers because they probably take more head trauma than any other sport. but it is not confined to boxers. obviously we are here today because of the same entity due to head trauma in the central. it has been reported in soccer players, it has been reported in rugby, in individuals that have head-banging disorders. it has been reported in a clown it has been reported in a clown that got it has been reported by a clown that was shot out of a cannon. it is not unique to the nfl.

>> commissioner goodell, director smith -- will you legacy the records? -- will you let us see the records? >> the answer is absolutely yes. we first discussed this last spring. we are going to make records available to them. >> yes, of course we will. >> thank you. madam dr. culverhouse? >> as one can imagine, my children were involved in football early on they went with me to games. they developed favorite players, players that took their time to give a handshake to my son or give my daughter or ride on his shoulders.

in january, i learned that one of those players who had stayed in tampa and started a successful business was dead. that man would, my son's favorite player -- batman wood, my son's favorite player, was getting lost trying to drive home from starbucks. and i met with batman and heard about his story, and i asked him about another player we had really liked. he said he was really bad. he was really bad. i said, i have got to find him. i need to help him. . scott brantly is in big trouble

now. he said to me this morning as i was coming over here, he said gay, you have always been a rebel, but you are a rebel with a cause. make them hear that we are hurt. make them hear that we can't fill out all of their forms. we can't do it. our mental capacity isn't there to answer the questions on the phone and fill out the forms. they are missing those of us that are severely disabled. so what i am doing with randy grimes and a number of my players is i am filling out the forms. i am going through the networks for them to access the benefits that they may be entitled to, which are not enough to sustain them monetarily. they are not enough. $5,000 for a hip replacement is not enough. i just had my knee done. i can tell you that for a big fact. but we've got to get proactive

for these players. so i am going to little rock, arkansas, to find jerry he could -- eckwad to take him to the doctor myself. i don't want to read about another one of my players is december. this isn't working for me. >> our ranking member, lamar smith. >> thank you, mr. chairman. i would like to address my first question to mr. goodell, dr. fisher and mr. martin. i know you all will come at the answer from different perspectives. mr. goodell, you may want to address ways that you and the players association can cooperate, or new rules that might come up. dr. tucker, you might address ee equipment. mr. martin you may have hoot your own experience. we have discussed a lot today about problems.

we have discussed a lot about past actions that have been taken. my question is what future actions should we take? what are the next steps to advance our understanding of the problem of head injuries, to try to improve treatment and to try to increase prevention of these head injuries? even though you have different perspectives, if you will talk about the future as opposed to the present or the past. >> let me try to address that without repeating a lot of the testimony. we have to continue to support this research and put more and more into this research so that we can find out exactly what are the medical facts. that is first, and we will continue to do that. the second thing we have to do is continue to prevent these injuries in the best way we can. that is rule changes that we have instituted that are making a difference. secondly, because of the research we have done, we have

made some very important changes to the equipment, particularly in the helmets and chin strams. -- chin straps. these are important issues in making the game safer. the other issue is education. for every player at every level in every sport is to make sure they are aware of the issues when you have a concussion. it is a serious injury, and you have to take it seriously and get medical care. >> thank you, mr. goodell. dr. tucker? >> at the risk of repeating some of the testimony, i will speak a little more specifically to equipment. we have made mention that research has shown that at least concussion that is occur in the nfl occur from blows to the side of the helmet and face mask. the helmet manufacturers have responded with change. the new helmets have that have

rolled out test better in the laboratory. so we are optimistic that the forces being imparted to the brain are showing that they are decreased compared to the older helmets. it won't eliminate concussions, but if we can decrease the risk, we will feel good about that. it will take more time, more study, and more meticulous tracking of these injuries, which we have been doing for a lot of years, to figure out whether the new helmets actually decrease the risk or occurrence of concussion in the nfl. over the last two years the number of concussions diagnosed and recorded have actually dropped slightly, but i wouldn't make much of that. it is premature to say. >> thank you. mr. martin, any practical advice you have for us? >> yes, sir. i am optimistic in this new spirit of cooperation that we can all come together with a

unique plan to address many of these serious issues. but the three points that i am concerned about particularly as it relates to a lot of the so-called heroes or constituents, we must determine and identify where they are. a lot of them value their anonymity. we want to make sure we have identified and embrace them. and we want to make sure the splinter or faction grooms are working for the same goal, to ensure these are not isolated incidents, and we can address them collectively. i am encouraged with this new platform we have. that is the message i am going to take from here. >> how many touchdowns did you score on interceptions or fumbles. >> i held the record for most

touchdowns by a defensive line, which was seven. however, i have one touchdown as an offensive lineman, which would make it eight. >> we will correct the record. >> so it is eight, sir. >> there is a university of michigan. how is your study misrepresented, and what impact has that head on the testimony? >> it has been misrepresented to the extent that it as been asserted there is a certainty that there is an elevated risk based on our study, which i don't believe there is. what harm? it focuses more on safety, and where is the arm in that? we have an epidemic of obesity in children. do we want to tell prospective

junior athletes that there is a 19-1 risk of dementia if you participate in the sport. that would be my main concern, that we are possibly frightening people away from healthy participation in sports. >> thank you. the member from north carolina. >> thank you, mr. chairman. let me thank the chairman for convening this hearing. it has been very enlightening. i especially want to express my thanks to the last two witness, the former players in the nfl, for the very balanced approach that they brought to their testimony. maybe i could get mr. smith to cut his microphone off over there?

thank you. i am also a big nfl football fan and certainly observed the change that has taken place in attitude about this issue. i am a big carolina panther fan and observed the dante wesley hit that got him suspended and knew in my own mind that several years ago the response to that would have been a 15-yard penalty, and that would have been the end of it. so i understand that there is a change of attitude taking place here. the one thing that i try to discern out of hearings of this

kind is what kind of public policy direction we might take. so i'm extremely pierre tiff to the last two witnesses for their balance on that, because after all these years, we still haven't taken any steps to outlaw or ban boxing, and i don't think we are likely to take any steps to outlaw or ban football. so we have to look at what the possible adjustments are short of that, that may be made either within the sport or from a public policy perspective. the one thing that i kept wondering about throughout the testimony, particularly mr. goodell, dr. culver house, mr. martin in particular, there

seem to be financial incentives that discourage athletes from being honest about their own condition even if they are capable of discerning their own conditioning. all of the counter precious are there for them to get back into the game -- counter pressures are there for them to get back into the game because there are financial incentives associated with that. is there a policy in place already in the nfl, or is there some kind of policy that you all might be able to think of that would minimize or

eliminate that financial incentive by assuring that a person who is diagnosed with a concussion and has to miss a game as a result of the standards that i think mr. martin or merrill outlined -- is there some way to build a contract necessity that would shield those players against the consequences of the medical conditions that they incur? mr. goodell, mrs. culverhouse, and i would be particularly interested, mr. martin, in your response to that? >> well, i would be happy to >> well, i would be happy to start.

self reporting has been an issue. we think by the education -- which we have jointly done with the players association -- >> you are evading the question again, mr. goodell. >> let me address that directly. if a player misses a game, the athletes still gets paid. >> but there are financial consequences at the end of the contract, there are economic consequences. is there a way to protect against that? >> the maybe some incentive projects -- there may be some incentive projects that may be hindered by that. that is something we would